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Benefits of Combined MRI Sequences in Meningioma Consistency Prediction: A Prospective Study of 287 Consecutive Patients

Objective  Consistency of meningiomas is one of the most important factors affecting the completeness of removal and major risks of meningioma surgery. This study used preoperative magnetic resonance imaging (MRI) sequences in single and in combination to predict meningioma consistency. Methods  The...

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Autores principales: Limpastan, Kriengsak, Unsrisong, Kittisak, Vaniyapong, Tanat, Norasetthada, Thunya, Watcharasaksilp, Wanarak, Jetjumnong, Chumpon
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Thieme Medical and Scientific Publishers Pvt. Ltd. 2022
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9771632/
https://www.ncbi.nlm.nih.gov/pubmed/36570751
http://dx.doi.org/10.1055/s-0042-1758849
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author Limpastan, Kriengsak
Unsrisong, Kittisak
Vaniyapong, Tanat
Norasetthada, Thunya
Watcharasaksilp, Wanarak
Jetjumnong, Chumpon
author_facet Limpastan, Kriengsak
Unsrisong, Kittisak
Vaniyapong, Tanat
Norasetthada, Thunya
Watcharasaksilp, Wanarak
Jetjumnong, Chumpon
author_sort Limpastan, Kriengsak
collection PubMed
description Objective  Consistency of meningiomas is one of the most important factors affecting the completeness of removal and major risks of meningioma surgery. This study used preoperative magnetic resonance imaging (MRI) sequences in single and in combination to predict meningioma consistency. Methods  The prospective study included 287 intracranial meningiomas operated on by five attending neurosurgeons at Chiang Mai University Hospital from July 2012 through June 2020. The intraoperative consistency was categorized in four grades according to the method of surgical removal and intensity of ultrasonic aspirator, then correlated with preoperative tumor signal intensity pattern on MRI including T1-weighted image, T2-weighted image (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted image (DWI), which were described as hypointensity, isointensity, and hyperintensity signals which were blindly interpreted by one neuroradiologist. Results  Among 287 patients, 29 were male and 258 female. The ages ranged from 22 to 83 years. A total of 189 tumors were situated in the supratentorial space and 98 were in the middle fossa and infratentorial locations. Note that 125 tumors were found to be of soft consistency (grades 1, 2) and 162 tumors of hard consistency (grades 3, 4). Hyperintensity signals on T2WI, FLAIR, and DWI were significantly associated with soft consistency of meningiomas (relative risk [RR] 2.02, 95% confidence interval [CI] 1.35–3.03, p  = 0.001, RR 2.19, 95% CI 1.43–3.35, p  < 0.001, and RR 1.47, 95% CI 1.02–2.11, p  = 0.037, respectively). Further, chance to be soft consistency significantly increased when two and three hyperintensity signals were combined (RR 2.75, 95% CI 1.62–4.65, p ≤ 0.001, RR 2.79, 95% CI 1.58–4.93, p  < 0.001, respectively). Hypointensity signals on T2WI, FLAIR, and DWI were significantly associated with hard consistency of meningiomas (RR 1.82, 95% CI 1.18–2.81, p  = 0.007, RR 1.80, 95% CI 1.15–2.83, p  = 0.010, RR 1.67, 95% CI 1.07–2.59, p  = 0.023, respectively) and chance to be hard consistency significantly increased when three hypointensity signals were combined (RR 1.82, 95% CI 1.11–2.97, p  = 0.017). Conclusion  T2WI, FLAIR, and DWI hyperintensity signals of the meningiomas was solely significantly associated with soft consistency and predictive value significantly increased when two and three hyperintensity signals were combined. Each of hypointensity signals on T2WI, FLAIR, and DWI was significantly associated with hard consistency of tumors and tendency to be hard consistency significantly increased when hypointensity was found in all three sequences.
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spelling pubmed-97716322022-12-22 Benefits of Combined MRI Sequences in Meningioma Consistency Prediction: A Prospective Study of 287 Consecutive Patients Limpastan, Kriengsak Unsrisong, Kittisak Vaniyapong, Tanat Norasetthada, Thunya Watcharasaksilp, Wanarak Jetjumnong, Chumpon Asian J Neurosurg Objective  Consistency of meningiomas is one of the most important factors affecting the completeness of removal and major risks of meningioma surgery. This study used preoperative magnetic resonance imaging (MRI) sequences in single and in combination to predict meningioma consistency. Methods  The prospective study included 287 intracranial meningiomas operated on by five attending neurosurgeons at Chiang Mai University Hospital from July 2012 through June 2020. The intraoperative consistency was categorized in four grades according to the method of surgical removal and intensity of ultrasonic aspirator, then correlated with preoperative tumor signal intensity pattern on MRI including T1-weighted image, T2-weighted image (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted image (DWI), which were described as hypointensity, isointensity, and hyperintensity signals which were blindly interpreted by one neuroradiologist. Results  Among 287 patients, 29 were male and 258 female. The ages ranged from 22 to 83 years. A total of 189 tumors were situated in the supratentorial space and 98 were in the middle fossa and infratentorial locations. Note that 125 tumors were found to be of soft consistency (grades 1, 2) and 162 tumors of hard consistency (grades 3, 4). Hyperintensity signals on T2WI, FLAIR, and DWI were significantly associated with soft consistency of meningiomas (relative risk [RR] 2.02, 95% confidence interval [CI] 1.35–3.03, p  = 0.001, RR 2.19, 95% CI 1.43–3.35, p  < 0.001, and RR 1.47, 95% CI 1.02–2.11, p  = 0.037, respectively). Further, chance to be soft consistency significantly increased when two and three hyperintensity signals were combined (RR 2.75, 95% CI 1.62–4.65, p ≤ 0.001, RR 2.79, 95% CI 1.58–4.93, p  < 0.001, respectively). Hypointensity signals on T2WI, FLAIR, and DWI were significantly associated with hard consistency of meningiomas (RR 1.82, 95% CI 1.18–2.81, p  = 0.007, RR 1.80, 95% CI 1.15–2.83, p  = 0.010, RR 1.67, 95% CI 1.07–2.59, p  = 0.023, respectively) and chance to be hard consistency significantly increased when three hypointensity signals were combined (RR 1.82, 95% CI 1.11–2.97, p  = 0.017). Conclusion  T2WI, FLAIR, and DWI hyperintensity signals of the meningiomas was solely significantly associated with soft consistency and predictive value significantly increased when two and three hyperintensity signals were combined. Each of hypointensity signals on T2WI, FLAIR, and DWI was significantly associated with hard consistency of tumors and tendency to be hard consistency significantly increased when hypointensity was found in all three sequences. Thieme Medical and Scientific Publishers Pvt. Ltd. 2022-12-10 /pmc/articles/PMC9771632/ /pubmed/36570751 http://dx.doi.org/10.1055/s-0042-1758849 Text en Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. ( https://creativecommons.org/licenses/by-nc-nd/4.0/ ) https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives License, which permits unrestricted reproduction and distribution, for non-commercial purposes only; and use and reproduction, but not distribution, of adapted material for non-commercial purposes only, provided the original work is properly cited.
spellingShingle Limpastan, Kriengsak
Unsrisong, Kittisak
Vaniyapong, Tanat
Norasetthada, Thunya
Watcharasaksilp, Wanarak
Jetjumnong, Chumpon
Benefits of Combined MRI Sequences in Meningioma Consistency Prediction: A Prospective Study of 287 Consecutive Patients
title Benefits of Combined MRI Sequences in Meningioma Consistency Prediction: A Prospective Study of 287 Consecutive Patients
title_full Benefits of Combined MRI Sequences in Meningioma Consistency Prediction: A Prospective Study of 287 Consecutive Patients
title_fullStr Benefits of Combined MRI Sequences in Meningioma Consistency Prediction: A Prospective Study of 287 Consecutive Patients
title_full_unstemmed Benefits of Combined MRI Sequences in Meningioma Consistency Prediction: A Prospective Study of 287 Consecutive Patients
title_short Benefits of Combined MRI Sequences in Meningioma Consistency Prediction: A Prospective Study of 287 Consecutive Patients
title_sort benefits of combined mri sequences in meningioma consistency prediction: a prospective study of 287 consecutive patients
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9771632/
https://www.ncbi.nlm.nih.gov/pubmed/36570751
http://dx.doi.org/10.1055/s-0042-1758849
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