Diffusion-Weighted MR Imaging: Diagnosing Atypical or Malignant Meningiomas and Detecting Tumor Dedifferentiation

Nagar, Veena; Ye, Jieru; Ng, Wai Hoe; Chan, Yun-Kai; Hui, Francis; Lee, C.K.; Lim, C. C. Tchoyoson

doi:10.3174/ajnr.a0996

Cited by 193 publications

(143 citation statements)

References 35 publications

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“…A little more than 100 cases of chordoid meningioma have been described in the English-language literature, the majority of which are in the pathology and neurosurgery literature. [4][5][6][7][8][9] Attempts to distinguish benign from atypical and malignant meningiomas have been undertaken with variable results, and DWI and ADC values have provided the most reliable means of differentiation, 10,11 though no data analysis specifically examining the chordoid morphologic variant has been performed. To the best of our knowledge, only 3 case reports in which the MR imaging characteristics of chordoid meningiomas were described have been published in the radiology literature.…”

Section: Resultsmentioning

confidence: 99%

“…Our findings differ from previously published data which reveal that atypical WHO grade II/III meningiomas show decreased ADC values consistent with a greater degree of restricted diffusion compared with that of typical WHO grade I meningioma subtypes. 10,11,20 It should be noted that these previous studies included fewer cases and that none included the chordoid variant. To our knowledge, ours is the largest case study to date and included 12 of the 15 meningioma variants, with the only subtype in our analysis demonstrating statistically significant differences in ADC values being the chordoid meningioma; these ADC values were elevated, not decreased, compared with those of typical WHO grade I meningiomas and all other subtypes.…”

Section: Discussionmentioning

confidence: 99%

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Chordoid Meningioma: Differentiating a Rare World Health Organization Grade II Tumor from Other Meningioma Histologic Subtypes Using MRI

Pond

Morgan²,

Hatanpaa³

et al. 2015

American Journal of Neuroradiology

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BACKGROUND AND PURPOSE:Meningiomas are very commonly diagnosed intracranial primary neoplasms, of which the chordoid subtype is seldom encountered. Our aim was to retrospectively review preoperative MR imaging of intracranial chordoid meningiomas, a rare WHO grade II variant, in an effort to determine if there exist distinguishing MR imaging characteristics that can aid in differentiating this atypical variety from other meningioma subtypes.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Chordoid Meningioma: Differentiating a Rare World Health Organization Grade II Tumor from Other Meningioma Histologic Subtypes Using MRI

Pond

Morgan²,

Hatanpaa³

et al. 2015

American Journal of Neuroradiology

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“…4,12,25,32,33,35,36 The absolute cutoff and reliability of ADC measurement is controversial, with different bvalues, areas of measurement (tumor peduncle, peripheral part of the tumor, and central region of the tumor), and methods of measurement (minimum ADC, mean ADC, maximum ADC, and normalized ADC) used in respective studies. Therefore, the ADC was not used as a possible predictor in our study.…”

Section: Discussionmentioning

confidence: 99%

Correlation between magnetic resonance imaging grading and pathological grading in meningioma

Lin

Chou

Kao³

et al. 2014

JNS

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Object This study investigated the specific preoperative MRI features of patients with intracranial meningiomas that correlate with pathological grade and provide appropriate preoperative planning. Methods From 2006 to 2012, 120 patients (36 men and 84 women, age range 20–89 years) with newly diagnosed symptomatic intracranial meningiomas undergoing resection were retrospectively analyzed in terms of radiological features of preoperative MRI. There were 90 WHO Grade I and 30 WHO Grade II or III meningiomas. The relationships between MRI features and WHO histopathological grade were analyzed and scored quantitatively. Results According to the results of multivariate logistic regression analysis, age ≥ 75 years, indistinct tumorbrain interface, positive capsular enhancement, and heterogeneous tumor enhancement were identified factors in the prediction of advanced histopathological grade. The prediction model was quantified as a scoring scale: 2 × (age) + 5 × (tumor-brain interface) + 3 × (capsular enhancement) + 2 × (tumor enhancement). The calculated score correlated positively with the probability of high-grade meningioma. Conclusions This scoring approach may be useful for clinicians in determining therapeutic strategy and in surgical planning for patients with intracranial meningiomas.

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“…include bone involvement, 34 epidermal growth factor receptor immunoreactivity, 41 non-skull base location, and male sex. 37 Newer imaging techniques, such as diffusion-weighted MRI, 35 diffusion-tensor imaging, 45 or thallium-201 SPECT, may help differentiate benign from atypical meningiomas, 43 although these modalities are unlikely to be widely used in the near future.…”

Section: 8mentioning

confidence: 99%

The role of radiotherapy following gross-total resection of atypical meningiomas

Komotar

Iorgulescu

Raper

et al. 2012

JNS

148

103

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Object Atypical (WHO Grade II) meningiomas comprise a heterogeneous group of tumors, with histopathology delineated under the guidance of the WHO and a spectrum of clinical outcomes. The role of postoperative radiotherapy for patients with atypical meningiomas who have undergone gross-total resection (GTR) remains unclear. In this paper, the authors sought to clarify this role by reviewing their experience over the past 2 decades. Methods The authors retrospectively analyzed all patients at their institution who underwent GTR between 1992 and 2011 with a final histology demonstrating atypical meningioma. Information regarding patients, tumor characteristics, and postoperative adjuvant therapy was gleaned from medical records. Time to recurrence and overall survival were analyzed using univariate, multivariate, and Kaplan-Meier survival analyses. Results Forty-five patients who met the inclusion criteria underwent GTR for atypical meningiomas. By a median follow-up of 44.1 months, 22% of atypical meningiomas had recurred. There was no recurrence in 12 (92%) of 13 patients who received postoperative radiotherapy or in 19 (59%) of 32 patients who did not undergo postoperative radiotherapy (p = 0.085), demonstrating a strong trend toward improved local control with postoperative radiotherapy. No other factors were significantly associated with recurrence in univariate or multivariate analyses. Conclusions This retrospective series supports the observation that postoperative radiotherapy likely results in lower recurrence rates of gross totally resected atypical meningiomas. Although a multicenter prospective trial will ultimately be needed to fully define the role of radiotherapy in managing gross totally resected atypical meningiomas, the authors' results contribute to a growing number of series that support routine postoperative radiotherapy as an adjuvant treatment for these lesions.

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Diffusion-Weighted MR Imaging: Diagnosing Atypical or Malignant Meningiomas and Detecting Tumor Dedifferentiation

Cited by 193 publications

References 35 publications

Chordoid Meningioma: Differentiating a Rare World Health Organization Grade II Tumor from Other Meningioma Histologic Subtypes Using MRI

Chordoid Meningioma: Differentiating a Rare World Health Organization Grade II Tumor from Other Meningioma Histologic Subtypes Using MRI

Correlation between magnetic resonance imaging grading and pathological grading in meningioma

The role of radiotherapy following gross-total resection of atypical meningiomas

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