In daily clinical practice, preoperative grading of meningioma is particularly important for selecting the best treatment strategy. Our hypothesis is that a combination of T1 mapping and diffusion weighted imaging (DWI) based on histogram analysis would be useful for differentiating between low-grade and high-grade meningiomas. Our study, for the first time, provides evidence that T1 mapping may be an imaging biomarker for differentiating grades and predicting the proliferation potential of meningiomas. The combination of T1 mapping and DWI showed the highest diagnostic performances in grading meningiomas.
Pathological grading of meningioma is insufficient to predict recurrence after resection and to guide individualized treatment strategies. One hundred and thirty-three patients with meningiomas who underwent total resection were enrolled in this retrospective study. Univariate analyses were conducted to evaluate the association between factors and recurrence. Least absolute shrinkage and selection operator (Lasso) was used to further select variables to build a logistic model. The predictive efficiency of the model and WHO grade was compared by using receiver operating characteristic curve (ROC), decision curve analysis (DCA), and net reclassification improvement (NRI). Patients were given a new risk layer based on a nomogram. The recurrence of meningioma in different groups was observed through the Kaplan-Meier curve. Univariate analysis demonstrated that 11 risk factors were associated with prognosis (P < 0.05). The result of ROC proved that the quantified risk-scoring system (AUC = 0.853) had a higher benefit than pathological grade (AUC = 0.689, P = 0.011). The incidence of recurrence of the high risk cohort (69%) was significantly higher than that of the low risk cohort (9%) by Kaplan-Meier analysis (P < 0.001). And all patients who did not relapse in the high risk group received adjuvant radiotherapy. The novel risk stratification algorithm has a significant value for the recurrence of meningioma and can help in optimizing the individualized design of clinical therapy.
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