Predicting the risk of postoperative recurrence and high-grade histology in patients with intracranial meningiomas using routine preoperative MRI

Abstract

Risk factors for prediction of prognosis in meningiomas derivable from routine preoperative magnetic resonance imaging (pMRI) remain elusive. Correlations of tumor and edema volume, disruption of the arachnoid layer, heterogeneity of contrast enhancement, enhancement of the capsule, T2-intensity, tumor shape, and calcifications on pMRI with tumor recurrence and high-grade (WHO grade II/III) histology were analyzed in 565 patients who underwent surgery for WHO grade I (N = 516, 91%) or II/III (high-grade histology, N = 49, 9%) meningioma between 1991 and 2018. Edema volume (OR, 1.00; p = 0.003), heterogeneous contrast enhancement (OR, 3.10; p < 0.001), and an irregular shape (OR, 2.16; p = 0.015) were associated with high-grade histology. Multivariate analyses confirmed edema volume (OR, 1.00; p = 0.037) and heterogeneous contrast enhancement (OR, 2.51; p = 0.014) as risk factors for high-grade histology. Tumor volume (HR, 1.01; p = 0.045), disruption of the arachnoid layer (HR, 2.50; p = 0.003), heterogeneous contrast enhancement (HR, 2.05; p = 0.007), and an irregular tumor shape (HR, 2.57; p = 0.001) were correlated with recurrence. Multivariate analyses confirmed tumor volume (HR, 1.01; p = 0.032) and disruption of the arachnoid layer (HR, 2.44; p = 0.013) as risk factors for recurrence, independent of histology. Subgroup analyses revealed disruption of the arachnoid layer (HR, 9.41; p < 0.001) as a stronger risk factor for recurrence than high-grade histology (HR, 5.15; p = 0.001). Routine pMRI contains relevant information about the risk of recurrence or high-grade histology of meningioma patients. Loss of integrity of the arachnoid layer on MRI had a higher prognostic value than the WHO grading, and underlying histological or molecular alterations remain to be determined.

A Novel MRI-Based Risk Stratification Algorithm for Predicting Postoperative Recurrence of Meningioma: More Benefits to Patients

“…Although we observed a trend towards an association between preoperative SKP and recurrence, it did not reach significance. We agreed with previous studies that the T2 relative high signal was generally not correlated with prognosis ( 4 , 6 , 12 , 13 , 15 ). The presence of linear enhancement of the dural caudate or adjacent dura may distinguish the meningioma from other intracranial masses following the use of contrast agents ( 34 ).…”

“…The observed association between cystic degeneration and high risk group was consistent with prior studies ( 8 ). Cyst formation in meningiomas may be associated with the rapid growth or aggressivity of tumor cells, including cystic variation, ischemic necrosis, direct liquid secretion by tumor cells, and absorption of intratumoral haemorrhage ( 4 , 8 , 12 , 15 ). Our results indicated significant differences in tumor shape and volume between the recurrent and non-recurrent groups.…”

“…Inflammatory cells tend to cluster in necrotic areas, while degraded tumor cells release proinflammatory cytokines which may stimulate angiogenesis and tumor progression ( 28 ). Most studies have suggested that heterogeneous enhancement is an independent predictor of high grade meningiomas and postoperative recurrence ( 4 , 6 , 11 , 12 , 14 , 15 , 20 , 25 ). Durand et al.…”

“…There were controversial reports about the influence of sex on meningioma recurrence. Some studies revealed that male patients had a high risk of recurrence ( 11 , 12 , 33 ), while others did not ( 6 , 9 , 13 , 17 , 25 ). Although we observed a trend towards an association between preoperative SKP and recurrence, it did not reach significance.…”

“…For every case, the representative hematoxylin-eosin (HE) staining slide which was most representative of the mitotic count or other grading standards was determined and calculated for the pathological grade by the experienced neuropathologist. Subsequently, WHO grade I meningiomas was defined as low grade meningiomas, and WHO grade II and III meningioma were defined as high grade meningiomas based on previous literature ( 3 , 6 , 11 , 12 ).…”