Growth dynamics of untreated meningiomas

Abstract

Background Knowledge about meningioma growth characteristics is needed for developing biologically rational follow-up routines. In this study of untreated meningiomas followed with repeated MRIs, we studied growth dynamics and explored potential factors associated with tumor growth. Methods In a single-center cohort study, we included 235 adult patients with a radiologically suspected intracranial meningioma and at least three MRI scans during follow-up. Tumors were segmented using an automatic algorithm from contrast enhanced T1-series, and if needed manually corrected. Potential meningioma growth curves were statistically compared; linear, exponential, linear radial, or Gompertzian. Factors associated with growth were explored. Results In 235 patients, 1394 MRI scans were carried out in the median five-year observational period. Of the models tested, a Gompertzian growth curve best described growth dynamics of meningiomas on group level. 59 % of the tumors grew, 27 % remained stable, and 14 % shrunk. Only 13 patients (5 %) underwent surgery during the observational period and were excluded after surgery. Tumor size at time of diagnosis, multifocality, and length of follow-up were associated with tumor growth, whereas age, sex, presence of peritumoral edema or hyperintense T2-signal were not significant factors. Conclusion Untreated meningiomas follow a Gompertzian growth curve, indicating that increasing and potentially doubling of subsequent follow-up intervals between MRIs seems biologically reasonable, instead of fixed time intervals. Tumor size at diagnosis is the strongest predictor of future growth, indicating a potential for longer follow up intervals for smaller tumors. Although most untreated meningiomas grow, few require surgery.