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MRI predictive score of pial vascularization of supratentorial intracranial meningioma

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Abstract

Objective

Meningiomas are highly vascularized tumors which may recruit pial blood supply. Pial supply complicates tumor treatment in numerous ways. The objective of this study was to establish a reliable MRI-based diagnostic score to predict the existence of pial blood supply in supratentorial intracranial meningiomas and then correlate the score with clinical and surgical outcomes and histopathological findings.

Methods

We performed a retrospective analysis of supratentorial histologically proven meningiomas in our institution from 2010 to 2018. A score was built based on MRI criteria and correlated with digital subtraction angiography (DSA) pial vascularization assessment. The score was then validated on a second independent population recruited with the same modalities.

Results

Logistic regression identified four parameters related to pial blood supply which were used to build the score: skull base location, tumor size > 45 mm, peritumoral flow voids, and incomplete cerebrospinal fluid rim. The overall diagnostic performance in predicting pial blood supply was as follows: sensitivity 97.8%, specificity 76.9%, predictive positive value 88.2%, negative predictive value 95.2%, and accuracy 90.3%. Inter-reader agreement and Cohen’s kappa were good, respectively, of 90.7% and 0.69. A high score was associated with aggressive meningioma (World Health Organization II–III) (p = 0.04) and with greater importance of pial supply relative to dural supply.

Conclusions

We have identified a reliable way to use MRI to predict the existence of pial blood supply in supratentorial intracranial meningiomas. A higher score also predicted higher grade meningioma.

Key Points

• Accurate and reproducible MRI score composed of four items to predict the existence of pial blood supply in supratentorial meningioma.

• High score is associated with high-grade meningioma (WHO II–III) but also with greater importance of pial supply relative to dural supply.

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Abbreviations

DSA:

Digital subtraction angiography

ECA:

External carotid artery

PTBE:

Peritumoral brain edema

WHO:

World Health Organization

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Centre Hospitalier et Universitaire Dupuytren, 2 Avenue Martin Luther King, 87042, Limoges, France

    Guillaume Friconnet, Victor Hugo Espíndola Ala, Clément Bogey, Suzana Saleme, Charbel Mounayer & Aymeric Rouchaud

  2. Department of Radiology, Fondation Adolphe-de-Rothschild, Paris, France

    Kevin Janot

  3. Department of Radiology, Mayo Clinic, Rochester, MN, USA

    Waleed Brinjikji

  4. Department of Neurosurgery, Centre Hospitalier et Universitaire Dupuytren, Limoges, France

    Leslie Lemnos & Henri Salle

  5. CNRS, XLIM, UMR 7252, F_87000, Limoges, France

    Charbel Mounayer & Aymeric Rouchaud

Authors
  1. Guillaume Friconnet
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  2. Victor Hugo Espíndola Ala
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  3. Kevin Janot
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  4. Waleed Brinjikji
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  5. Clément Bogey
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  6. Leslie Lemnos
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  7. Henri Salle
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  8. Suzana Saleme
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  9. Charbel Mounayer
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  10. Aymeric Rouchaud
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Corresponding author

Correspondence to Guillaume Friconnet.

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Guarantor

The scientific guarantor of this publication is Aymeric Rouchaud.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was waived by the Institutional Review Board.

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Institutional Review Board approval was obtained.

Methodology

• Retrospective

• Diagnostic or prognostic study/observational

• multicenter study

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Friconnet, G., Espíndola Ala, V.H., Janot, K. et al. MRI predictive score of pial vascularization of supratentorial intracranial meningioma. Eur Radiol 29, 3516–3522 (2019). https://doi.org/10.1007/s00330-019-06197-6

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  • DOI: https://doi.org/10.1007/s00330-019-06197-6

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