Diffusion tensor magnetic resonance imaging for predicting the consistency of intracranial meningiomas

Romani, Rossana; Tang, Weijun; Mao, Ying; Wang, Daijun; Zhu, Fengping; Che, Xiaoming; Gong, Yi; Zheng, Kewen; Zhong, Ping; Li, Shiqi; Bao, Weimin; Benner, Christian; Wu, Jiang; Zhou, Lei

doi:10.1007/s00701-014-2149-y

Cited by 37 publications

(44 citation statements)

References 18 publications

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“…Similarly, Kashimura et al found that there was no association between T2WI and consistency 25 . A more recent larger series from Romani et al also found no association using T1- or T2WI, as well as FLAIR or proton density weighted imaging (PDWI) 26 . However, several other studies have found MRI techniques other than T2WI like FLAIR and PDWI were indeed associated with consistency 4,7,8 .…”

Section: Neuroimaging Studies Of Meningioma Consistencymentioning

confidence: 94%

“…Fibrous content has been thought to underlie a given FA value where parallel-oriented cellular membranes result in diffusion preferentially in one direction while being restricted along other axes 4 . A recent large prospective series of 110 meningiomas by Romani et al also found that the quantitative FA value as well as signal intensity on FA and mean diffusivity (MD) maps were predictive of meningioma consistency 26 . Using rigorous statistical methodology with a relatively large sample size, they determined an impressive AUC of 0.9459.…”

Section: Neuroimaging Studies Of Meningioma Consistencymentioning

confidence: 96%

“…Other factors that could be determined from conventional MRI images such as contrast enhancement on T1WI, presence of cystic components, peritumoral vasogenic edema, brain-tumor contact interface or bony appearance also have not been associated with tumor consistency in several studies 8,20,21,26 . Furthermore, neither angiographic characteristics nor clinical factors such as gender or age have been associated with consistency.…”

Section: Neuroimaging Studies Of Meningioma Consistencymentioning

confidence: 99%

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Predicting Meningioma Consistency on Preoperative Neuroimaging Studies

Shiroishi

Cen

Tamrazi

et al. 2016

Neurosurgery Clinics of North America

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Synopsis This article provides an overview of the neuroimaging literature focused on pre-operative prediction of meningioma consistency. A validated, non-invasive neuroimaging method to predict tumor consistency can provide valuable information regarding neurosurgical planning and patient counseling. Most of the neuroimaging literature indicates conventional MRI using T2-weighted imaging (T2WI) may be helpful to predict meningioma consistency, however, further rigorous validation is necessary. Much less is known about advanced MRI techniques such as diffusion MRI, MR elastography (MRE) and MR spectroscopy (MRS). Of these methods, MRE and DTI appear particularly promising.

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Section: Neuroimaging Studies Of Meningioma Consistencymentioning

confidence: 94%

Section: Neuroimaging Studies Of Meningioma Consistencymentioning

confidence: 96%

Section: Neuroimaging Studies Of Meningioma Consistencymentioning

confidence: 99%

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Predicting Meningioma Consistency on Preoperative Neuroimaging Studies

Shiroishi

Cen

Tamrazi

et al. 2016

Neurosurgery Clinics of North America

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“…The most accurate model for predicting a hard-consistency meningioma is an isointense signal in mean diffusivity maps, a hyperintense signal in FA maps, and an FA value of more than 0.3. 6 MRS may show high alanine and low N-acetylaspartate peaks in meningiomas but it is difficult to perform due to their location near the skull base and bone artefacts especially in the cerebellopontine angle, thus making this technique limited mainly to large lesions. 7 …”

Section: Meningiomamentioning

confidence: 99%

Imaging of skull base pathologies: Role of advanced magnetic resonance imaging techniques

et al. 2015

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Imaging plays a vital role in evaluation of skull base pathologies as this region is not directly accessible for clinical evaluation. Computerized tomography (CT) and magnetic resonance imaging (MRI) have played complementary roles in the diagnosis of the various neoplastic and non-neoplastic lesions of the skull base. However, CT and conventional MRI may at times be insufficient to correctly pinpoint the accurate diagnosis. Advanced MRI techniques, though difficult to apply in the skull base region, in conjunction with CT and conventional MRI can however help in improving the diagnostic accuracy. This article aims to highlight the importance of advanced MRI techniques like diffusion-weighted imaging, susceptibility-weighted imaging, perfusion-weighted imaging, and MR spectroscopy in differentiation of various lesions involving the skull base.

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“…The techniques to define mechanical properties are partially already available, but they must be integrated into clinical routine [10,11,15]. The techniques to define interfaces are also available with the heavily contrasted T2-weighted series such as (constructive interference in steady state [CISS]).…”

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confidence: 99%

Surgical management of medium and large petroclival meningiomas: benchmark and limits

Steiger

2016

Acta Neurochir

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Da Li and co-workers present a detailed sub-analysis of their series of petroclival meningiomas, which is the largest monocentric series published to date [5,6]. In the current work, they restrict the analysis to medium and large tumours of more than 2 cm in diameter-the tumours that really cause difficulties for microsurgery as well as stereotactic radiosurgery. Gross total resection was achieved in 56 % of patients; dysfunctions of the cranial nerves were the most common complication and occurred in two-thirds of the patients. Immediately following surgery, morbidity temporarily increased and the Karnovsky Performance Scale temporarily decreased on average. The case fatality rate amounted to 2 %. Permanent surgical morbidity remained in 20 % of patients during the average long-term follow-up of almost 10 years, but significantly more patients lived independently after than before surgery (61 vs 46 %). One-fourth of patients were lost to longterm follow-up, so that the numbers regarding long-term outcome must be appreciated with sound judgment.These key data focusing on medium and large petroclival meningioma are important, although difficult to compare with the smaller unselected series [1,3,[7][8][9]12]. Petroclival meningiomas smaller than 2 cm carry a much smaller surgical risk than large tumours, and in unselected series the small tumours dilute information regarding the problematic larger tumours. Numbers for the rate of gross total resection and surgical morbidities given in the published unselected series differ widely: gross total resection between one-third and twothirds, and surgical morbidity also between one-third and twothirds.Stereotactic radiosurgery is an obvious alternative for primary treatment of these tumours. There are not very many reports-a fact that reflects concerns regarding tolerance in view of the vicinity of the brainstem. The Pittsburgh group reported their experience in a series of 39 patients with a median follow-up period of 37 months. Neurological status improved in 21 %, remained stable in 66 %, and eventually worsened in 13 %. Tumour volumes decreased in 23 %, remained stable in 68 % and increased in 8 % [13]. It appears that there is some kind of consensus that radiosurgery is an adjuvant modality for larger petroclival meningiomas, which cannot be recommended as first-line therapy. However, there is little doubt that in analogy to vestibular schwannomas, stereotactic radiosurgery has evolved to an alternative for smallsized meningiomas.The substantial proportion of incomplete removal in most series and the significant rate of morbidity suggest that petroclival meningiomas remain not only difficult but basically problematic for microsurgery. Finding the balance between radicality and risk is the real challenge of managing petroclival meningiomas. The surgical risk appears to be influenced by (1) tumour size, (2) consistency and texture of the tumour and (3) the interface between tumour and arteries, brainstem and cranial nerves. In my opinion, it is hardly possible to disse...

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Diffusion tensor magnetic resonance imaging for predicting the consistency of intracranial meningiomas

Abstract: FA value and MD and FA maps are useful for prediction of meningioma consistency and, therefore, may be considered in the preoperative routine MRI examination of all patients with intracranial meningiomas.

Cited by 37 publications

References 18 publications

Predicting Meningioma Consistency on Preoperative Neuroimaging Studies

Predicting Meningioma Consistency on Preoperative Neuroimaging Studies

Imaging of skull base pathologies: Role of advanced magnetic resonance imaging techniques

Surgical management of medium and large petroclival meningiomas: benchmark and limits

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