Imaging and extent of surgical resection predict risk of meningioma recurrence better than WHO histopathological grade

Hwang, William L.; Marciscano, Ariel E.; Niemierko, Andrzej; Kim, Daniel W.; Stemmer‐Rachamimov, Anat; Curry, William T.; Barker, Fred G.; Martuza, Robert L.; Loeffler, Jay S.; Oh, Kevin; Shih, Helen A.; Larvie, Mykol

doi:10.1093/neuonc/nov285

Cited by 108 publications

(90 citation statements)

References 50 publications

(35 reference statements)

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“…Even though calcification is neither a defining part of the WHO grading nor of the MIB‐1 proliferation index, both histologic grade and the proliferation index have been demonstrated to be significantly related to the presence of calcification . At this, the presence of calcification was suggested to significantly lower the odds of a high‐grade histopathology as well as a high MIB‐1 proliferation index, whereas the absence of calcification was shown to be an independent risk factor . As a consequence, there is evidence to support the clinical application of a noninvasive approach such as the assessment of intratumoral calcification to predict meningioma consistency.…”

Section: Discussionmentioning

confidence: 99%

“…While WHO grade II and III tumors are more locally aggressive and have a higher rate of progression and recurrence, benign grade I meningiomas are recognized by their lack of anaplastic features with a comparably low rate of recurrence . It has been argued that the histologic grading alone does not reliably predict patients' progression and recurrence after treatment …”

Section: Discussionmentioning

confidence: 99%

“…Here, the determination of proliferative activity based on the MIB‐1 proliferation index has become a diagnostic tool for the identification of more aggressive meningiomas as well as a useful predictor of tumor grade and risk of recurrence . Even though calcification is neither a defining part of the WHO grading nor of the MIB‐1 proliferation index, both histologic grade and the proliferation index have been demonstrated to be significantly related to the presence of calcification . At this, the presence of calcification was suggested to significantly lower the odds of a high‐grade histopathology as well as a high MIB‐1 proliferation index, whereas the absence of calcification was shown to be an independent risk factor .…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Assessment of intracranial meningioma‐associated calcifications using susceptibility‐weighted MRI

Adams

Böker

Bender

et al. 2017

Magnetic Resonance Imaging

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Assessment of intracranial meningioma‐associated calcifications using susceptibility‐weighted MRI

Adams

Böker

Bender

et al. 2017

Magnetic Resonance Imaging

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“…Diffusion imaging is a sensitive imaging biomarker, representing cellularity and extracellular free water content, and has shown promise as a robust approach for preoperative tumor typing, 47 preoperative glioma grading, 1,44,50 posttreatment glioma responses, 6,42 and meningioma grading and prediction of postoperative recurrence. 20,43 In addition, the ADC value is reported as a practical method for evaluating the efficacy of stereotactic radiosurgery and predicting early intracranial metastatic response to GKS. 26 Cellular density is considered a major factor responsible for changes in ADCs.…”

Section: Adc Values As Useful Predictors Of Early Vs Response Followimentioning

confidence: 99%

Magnetic resonance imaging characteristics and the prediction of outcome of vestibular schwannomas following Gamma Knife radiosurgery

Wu¹,

Guo²,

Chung

et al. 2017

Journal of Neurosurgery

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OBJECTIVE Gamma Knife surgery (GKS) is a promising treatment modality for patients with vestibular schwannomas (VSs), but a small percentage of patients have persistent postradiosurgical tumor growth. The aim of this study was to determine the clinical and quantitative MRI features of VS as predictors of long-term tumor control after GKS. METHODS The authors performed a retrospective study of all patients with VS treated with GKS using the Leksell Gamma Knife Unit between 2005 and 2013 at their institution. A total of 187 patients who had a minimum of 24 months of clinical and radiological assessment after radiosurgery were included in this study. Those who underwent a craniotomy with tumor removal before and after GKS were excluded. Study patients comprised 85 (45.5%) males and 102 (54.5%) females, with a median age of 52.2 years (range 20.4-82.3 years). Tumor volumes, enhancing patterns, and apparent diffusion coefficient (ADC) values were measured by region of interest (ROI) analysis of the whole tumor by serial MRI before and after GKS. RESULTS The median follow-up period was 60.8 months (range 24-128.9 months), and the median treated tumor volume was 3.54 cm (0.1-16.2 cm). At last follow-up, imaging studies indicated that 150 tumors (80.2%) showed decreased tumor volume, 20 (10.7%) had stabilized, and 17 (9.1%) continued to grow following radiosurgery. The postradiosurgical outcome was not significantly correlated with pretreatment volumes or postradiosurgical enhancing patterns. Tumors that showed regression within the initial 12 months following radiosurgery were more likely to have a larger volume reduction ratio at last follow-up than those that did not (volume reduction ratio 55% vs 23.6%, respectively; p < 0.001). Compared with solid VSs, cystic VSs were more likely to regress or stabilize in the initial postradiosurgical 6-12-month period and during extended follow-up. Cystic VSs exhibited a greater volume reduction ratio at last follow-up (cystic vs solid: 67.6% ± 24.1% vs 31.8% ± 51.9%; p < 0.001). The mean preradiosurgical maximum ADC (ADC) values of all VSs were significantly higher for those with tumor regression or stabilization at last follow-up compared with those with progression (2.391 vs 1.826 × 10 mm/sec; p = 0.010). CONCLUSIONS Loss of central enhancement after radiosurgery was a common phenomenon, but it did not correlate with tumor volume outcome. Preradiosurgical MRI features including cystic components and ADC values can be helpful as predictors of treatment outcome.

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“…Imaging characteristics such as low apparent diffusion coefficient on MRI may be additional predictors of progression or recurrence. 81 Increasing knowledge of the genetic landscape of meningiomas has further improved prognostic understanding. Increased expression of MYCN, mutations in SMO and AKT1, deletions in the 9p21 region (including the CDKN2A gene), increased programmed death-ligand 1 (PD-L1) expression, gain of 1p, and deletion of 14q have all been associated with poor prognosis.…”

Section: Prognosismentioning

confidence: 99%

Meningiomas: Overview and New Directions in Therapy

Wang

Osswald

2018

Semin Neurol

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The majority of meningiomas, the most common primary brain tumor, are considered to be benign, and characteristic magnetic resonance imaging features allow a preliminary diagnosis. Meningiomas can be classified in the World Health Organization system as grade I, II, or III, depending on various histological features. In many cases, observation is the preferred management option, although this means the absence of a histological diagnosis. If necessary, standard therapy consists of surgery with or without adjuvant radiation, depending on the tumor grade and the degree of resection. To date, systemic therapies are not included in the standard of care. The level of evidence for treatment recommendations is low, and effective treatment regimens, especially for surgery-refractory and radiation-refractory meningiomas, are still very limited. Recent studies have broadened our knowledge of the genetics and pathogenesis of meningiomas and will lead to new therapeutic options. This review summarizes the epidemiology, pathogenesis and genetics, classification, and diagnosis of meningiomas, as well as management principles, including promising new avenues of therapy.

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Imaging and extent of surgical resection predict risk of meningioma recurrence better than WHO histopathological grade

Abstract: Patients with non-Simpson grade I resection and low ADC meningiomas are at significantly increased risk of P/R and may benefit from adjuvant radiotherapy and/or additional surgery.

Cited by 108 publications

References 50 publications

Assessment of intracranial meningioma‐associated calcifications using susceptibility‐weighted MRI

Assessment of intracranial meningioma‐associated calcifications using susceptibility‐weighted MRI

Magnetic resonance imaging characteristics and the prediction of outcome of vestibular schwannomas following Gamma Knife radiosurgery

Meningiomas: Overview and New Directions in Therapy

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