Predicting the grade of meningiomas by clinical–radiological features: A comparison of precontrast and postcontrast MRI

Abstract

ObjectivesPostcontrast magnetic resonance imaging (MRI) is important for the differentiation between low-grade (WHO I) and high-grade (WHO II/III) meningiomas. However, nephrogenic systemic fibrosis and cerebral gadolinium deposition are major concerns for postcontrast MRI. This study aimed to develop and validate an accessible risk-scoring model for this differential diagnosis using the clinical characteristics and radiological features of precontrast MRI.MethodsFrom January 2019 to October 2021, a total of 231 meningioma patients (development cohort n = 137, low grade/high grade, 85/52; external validation cohort n = 94, low-grade/high-grade, 60/34) were retrospectively included. Fourteen types of demographic and radiological characteristics were evaluated by logistic regression analyses in the development cohort. The selected characteristics were applied to develop two distinguishing models using nomograms, based on full MRI and precontrast MRI. Their distinguishing performances were validated and compared using the external validation cohort.ResultsOne demographic characteristic (male), three precontrast MRI features (intratumoral cystic changes, lobulated and irregular shape, and peritumoral edema), and one postcontrast MRI feature (absence of a dural tail sign) were independent predictive factors for high-grade meningiomas. The area under the receiver operating characteristic (ROC) curve (AUC) values of the two distinguishing models (precontrast–postcontrast nomogram vs. precontrast nomogram) in the development cohort were 0.919 and 0.898 and in the validation cohort were 0.922 and 0.878. DeLong’s test showed no statistical difference between the AUC values of the two distinguishing models (p = 0.101).ConclusionsAn accessible risk-scoring model based on the demographic characteristics and radiological features of precontrast MRI is sufficient to distinguish between low-grade and high-grade meningiomas, with a performance equal to that of a full MRI, based on radiological features.

Impact of Shape Irregularity in Medial Sphenoid Wing Meningiomas on Postoperative Cranial Nerve Functioning, Proliferation, and Progression-Free Survival

“…The shape of meningiomas is often classified as regular or irregular based on their margins and infiltrative patterns. Irregular shape is thought to result from substantial heterogeneity in proliferative activity in various subregions of the tumor, with some areas exhibiting significantly increased growth rates [ 37 , 38 ]. Thus, meningioma shape has been suggested as a means to estimate the meningioma grade preoperatively [ 39 ].…”

“…We found that irregularly shaped MSWMs are an independent risk factor for a shortened time to tumor progression. There may be several reasons to explain this finding: (1) Irregular shape may result from increased proliferative potential, which can enhance tumor progression [ 37 , 38 ]. This finding is consistent with our study’s results, which identified irregular shape as an independent preoperative imaging-derived risk factor, estimating an increased MIB-1 labeling index in MSWMs.…”

Association of quantitative radiomic shape features with functional outcome after surgery for primary sporadic dorsal spinal meningiomas

“…Meningiomas are often categorized into regularly or irregularly shaped tumors based on the characteristics of their margins and infiltrative growth patterns. The irregular shape is assumed to be caused by significant variations in the rate of cell proliferation within different subregions of the tumor, with certain areas displaying notably accelerated growth rates ( 30 , 31 ). Hence, the shape of meningiomas has been proposed as a potential indicator of meningioma grade ( 32 ).…”