Prediction of brain invasion in patients with meningiomas using preoperative magnetic resonance imaging
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Alborz Adeli1, Katharina Hess2, Christian Mawrin3, Eileen Maria Susanne Streckert4, Walter Stummer4, Werner Paulus2, André Kemmling1, Markus Holling4, Walter Heindel1, Rene Schmidt5, Dorothee Cäcilia Spille5,*, Peter B. Sporns1,* and Benjamin Brokinkel4,*
1Institute of Clinical Radiology, University of Münster, Münster, North Rhine-Westphalia, Germany
2Institute of Neuropathology, University Hospital Münster, Münster, North Rhine-Westphalia, Germany
3Institute of Neuropathology, Otto-von-Guericke University, Magdeburg, Saxony-Anhalt, Germany
4Department of Neurosurgery, University Hospital Münster, Münster, North Rhine-Westphalia, Germany
5Institute of Biostatistics and Clinical Research, University of Münster, Münster, North Rhine-Westphalia, Germany
*These authors have contributed equally to this work
Benjamin Brokinkel, email: [email protected]
Keywords: brain invasion; grading; meningioma; magnetic resonance imaging; radiology
Received: July 22, 2018 Accepted: October 25, 2018 Published: November 13, 2018
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.
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