Can MRI predict meningioma consistency?: a correlation with tumor pathology and systematic review

Abstract

Tumor consistency is a critical factor that influences operative strategy and patient counseling. Magnetic resonance imaging (MRI) describes the concentration of water within living tissues and as such, is hypothesized to predict aspects of their biomechanical behavior. In meningiomas, MRI signal intensity has been used to predict the consistency of the tumor and its histopathological subtype, though its predictive capacity is debated in the literature. We performed a systematic review of the PubMed database since 1990 concerning MRI appearance and tumor consistency to assess whether or not MRI can be used reliably to predict tumor firmness. The inclusion criteria were case series and clinical studies that described attempts to correlate preoperative MRI findings with tumor consistency. The relationship between the pre-operative imaging characteristics, intraoperative findings, and World Health Organization (WHO) histopathological subtype is described. While T2 signal intensity and MR elastography provide a useful predictive measure of tumor consistency, other techniques have not been validated. T1-weighted imaging was not found to offer any diagnostic or predictive value. A quantitative assessment of T2 signal intensity more reliably predicts consistency than inherently variable qualitative analyses. Preoperative knowledge of tumor firmness affords the neurosurgeon substantial benefit when planning surgical techniques. Based upon our review of the literature, we currently recommend the use of T2-weighted MRI for predicting consistency, which has been shown to correlate well with analysis of tumor histological subtype. Development of standard measures of tumor consistency, standard MRI quantification metrics, and further exploration of MRI technique may improve the predictive ability of neuroimaging for meningiomas.

Tumor to Cerebellar Peduncle T2-Weighted Imaging Intensity Ratio Fails to Predict Pituitary Adenoma Consistency

“…14,15 The TCTI ratio offers a simple way to normalize the T2W intensity, has been extensively characterized in meningiomas, and has shown to strongly correlate with tumor consistency. [9][10][11] The use of this ratio in pituitary adenomas has offered promising results in a small cohort. 12 Using a large cohort, we show that the TCTI ratio does not correlate well with tumor consistency and does not offer predictive value in this context.…”

“…TCTI ratio strongly correlates with tumor consistency, and TCTI ratios >1.8 correlate with softer tumors. [9][10][11] A recent study demonstrated that the use of the ratio of signal intensity of pituitary adenoma to cerebellar peduncle on T2W imaging (TCTI) correlates well with tumor consistency, and all six firm tumors in their series had a TCTI <1.8. 12 We therefore sought to validate these results in a larger patient cohort.…”

Fully automated detection and segmentation of meningiomas using deep learning on routine multiparametric MRI

“…MRI is the key method for diagnosis and characterisation of meningiomas, resection planning, therapy decisions and monitoring of therapy [5,7,10]. Typical meningiomas occur sessile or lentiform in shape and are sharply circumscribed showing wide dural attachments.…”

Can an Imaging Marker of Consistency Predict Intraoperative Experience and Clinical Outcomes for Vestibular Schwannomas? A Retrospective Review

“…It is also relevant to mention that a prior meta-analysis regarding meningiomas and predicting consistency based on imaging found that all studies that relied on quantitative assessment of tumor signal intensity found a correlation between intensity and consistency for these tumors. 22 The only studies that did not find a correlation for this pathology were those that used a qualitative assessment. 22 It seems likely that a similar trend would be true with VSs, which could explain why the study by Rizk et al did not find the strong correlation identified by the Copeland et al 17,18 These aforementioned studies additionally identified a trend toward and correlation between consistency and CN VII outcomes, at least initially in the postoperative period.…”

“…18 Preoperative neuroimaging as a predictor of internal tumor consistency, a concept that is utilized frequently with other benign brain tumors, is incompletely understood for VSs. [19][20][21][22] Copeland et al determined that T2-weighted magnetic resonance imaging (MRI) protocols can be utilized to determine consistency of VSs, with hyperintensity signifying a softer tumor. 17 Contrarily, Rizk et al found that T2 intensity did not correlate with consistency of the tumor intraoperatively, while widening of the internal auditory canal (IAC) on computed tomography (CT) imaging did correlate with firm tumors significantly widening the IAC compared with soft tumors.…”