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. 2018 Nov 13;9(89):35974-35982.
doi: 10.18632/oncotarget.26313.

Prediction of brain invasion in patients with meningiomas using preoperative magnetic resonance imaging

Alborz Adeli  1 , Katharina Hess  2 , Christian Mawrin  3 , Eileen Maria Susanne Streckert  4 , Walter Stummer  4 , Werner Paulus  2 , André Kemmling  1 , Markus Holling  4 , Walter Heindel  1 , Rene Schmidt  5 , Dorothee Cäcilia Spille  5 , Peter B Sporns  1 , Benjamin Brokinkel  4
Affiliations

Prediction of brain invasion in patients with meningiomas using preoperative magnetic resonance imaging

Alborz Adeli et al. Oncotarget. .

Abstract

Brain invasion (BI) in meningiomas impacts WHO grading and therefore adjuvant treatment. However, BI is rare and neurosurgical sampling and neuropathological analyses are not standardised. Moreover, associations with imaging findings are sparsely known. Associations between BI and findings on preoperative MRI were investigated in 617 meningioma patients. BI was strongly correlated with other high-grade criteria (p<.001). Presence of a contrast enhancing tumour capsule, disruption of the arachnoid layer, intratumoural calcifications and T2-intensity were not related to high-grade histology or BI (p>.05, each). High-grade histology (p=.033) but not BI (p=.354) was associated with tumour location. Irregular tumour shape (OR: 3.33, 95%CI 1.33-8.30; p=.007), heterogeneous contrast enhancement (OR: 2.82, 95%CI 1.19-6.70; p=.015) and peritumoural edema (OR: 1.005 per ccm, 95%CI 1.001-1.008); p=.011) were associated with BI. Multivariable analyses identified only increasing edema volume (OR: 1.005 per ccm, 95%CI 1.002-1.009; p=.010) as a predictor for BI, independent of other histopathological high-grade criteria. We finally provide a new model to estimate the risk of BI using routine preoperative MRI. Several imaging characteristics were identified as predictors for BI. Consideration in clinical routine can increase the accuracy of the detection in neuropathological analyses.

Keywords: brain invasion; grading; magnetic resonance imaging; meningioma; radiology.

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Conflict of interest statement

CONFLICTS OF INTEREST The authors report no conflict of interest concerning the material or methods used in this study or the findings specified in this paper.

Figures

Figure 1
Figure 1. Boxpots visualizing the degree of association between peritumoural edema (PTBE) volume and histopathological findings
High-grade histology was associated with increased PTBE volume (left, p=.002) and PTBE volumes were larger in invasive than in non-invasive meningiomas (p<.001, right). However, no association was found between edema volume and other histopathological grading criteria (p=.117). The boxes indicate upper and lower 25% quartile, the whiskers the minimum/maximum value within 1.5 IQR of the lower/upper quartile, the dots the outliers, the asterisks the extreme values, and the heavy horizontal line indicates the median (ccm=cubic centimeter, *high-grade=grade II and III meningiomas.).
Figure 2
Figure 2. Prediction of brain invasion using findings on preoperative MRI
Predicted probability of brain invasive growth depending on PTBE volume in females (A) and males (B) according to the final multivariable model (Table 2).
Figure 3
Figure 3. Illustrative examples of the analyzed MRI variables
In (A), axial T2-weighted MRI shows cerebrospinal fluid at the brain/meningioma border (arrow), indicating a distinct tumour surface with an intact arachnoid layer. In (B and C), sagittal T1-weighted images show a contrast-enhancing tumour capsule (B, arrow), a heterogeneous gadolinium enhancement (C) and an irregular tumour shape with mushroom-like growth (C).
See this image and copyright information in PMC

References

    1. Perry A, Louis DN, von Deimling A, Sahm F, Rushing EJ, Mawrin C, Claus EB, Loeffler J, Sadetzki S. Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD, Cavenee WK, Ellison DW, Figarella-Branger D, Perry A, Reifenberger G, von Deimlig A, editors. WHO Classification of Tumors of the Central Nervous System. Lyon: International Agency on Cancer Research; 2016. pp. 232–45.
    1. Heß K, Spille DC, Wagner A, Stummer W, Paulus W, Brokinkel B. Letter: brain invasion in meningiomas-sex-associated differences are not related to estrogen- and progesterone receptor expression. Neurosurgery. 2017;81:E25–27. https://doi.org/10.1093/neuros/nyx147 - DOI - PubMed
    1. Goldbrunner R, Minniti G, Preusser M, Jenkinson MD, Sallabanda K, Houdart E, von Deimling A, Stavrinou P, Lefranc F, Lund-Johansen M, Moyal EC, Brandsma D, Henriksson R, et al. EANO guidelines for the diagnosis and treatment of meningiomas. Lancet Oncol. 2016;17:e383–91. https://doi.org/10.1016/S1470-2045(16)30321-7 - DOI - PubMed
    1. Brokinkel B, Hess K, Mawrin C. Brain invasion in meningiomas-clinical considerations and impact of neuropathological evaluation: a systematic review. Neuro-oncol. 2017;19:1298–307. https://doi.org/10.1093/neuonc/nox071 - DOI - PMC - PubMed
    1. Jenkinson MD, Santarius T, Zadeh G, Aldape KD. Atypical meningioma-is it time to standardize surgical sampling techniques? Neuro Oncol. 2017;19:453–54. https://doi.org/10.1093/neuonc/now245 - DOI - PMC - PubMed

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