ADC histogram parameters differentiating atypical from transitional meningiomas: correlation with Ki-67 proliferation index

Abstract

Purpose: To investigate the role of apparent diffusion coefficient (ADC) histogram analysis in differentiating atypical meningioma (AtM) from transitional meningioma (TrM) and its correlation with the Ki-67 proliferation index. Methods: Clinical, imaging, and pathological data of 78 patients with AtM and 80 patients with TrM were retrospectively collected. Regions of interest (ROIs) were delineated on axial ADC images using MaZda software and histogram parameters (mean, variance, skewness, kurtosis, 1st percentile (ADCp1), 10th percentile (ADCp10), 50th percentile (ADCp50), 90th percentile (ADCp90), and 99th percentile (ADCp99)) were generated. The Mann–Whitney U test was used to compare the differences in histogram parameters between the two groups; receiver operating characteristic (ROC) curves were used to assess diagnostic efficacy in differentiating AtM from TrM preoperatively. The correlation between histogram parameters and Ki-67 proliferation index was analyzed. Results: All histogram parameters of AtM were lower than those of TrM, and the variance, skewness, kurtosis, ADCp90, and ADCp99 were significantly different (P < 0.05). The optimal cutoff value of 147.00 × 10 – 3 mm2/s, ADCp99 achieved the best diagnostic performance for distinguishing AtM from TrM: area under the curve (AUC), sensitivity, specificity, accuracy, positive predictive value, and negative predictive value were 0.764, 58.75%, 82.05%, 70.25%, 77.05%, and 65.98%, respectively. All histogram parameters were negatively correlated with Ki-67 expression (r = -0.012 to -0.293). Conclusion: ADC histogram analysis is a potential tool for noninvasive differentiation of AtM from TrM preoperatively, and ADC histogram parameters were negatively correlated with the Ki-67 proliferation index.