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Diffusion-weighted imaging does not predict histological grading in meningiomas

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Abstract

Purpose

This study aims to verify the reliability of diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurements to differentiate benign from atypical/malignant meningiomas and among different sub-types.

Methods

Pre-operative DWI of 102 patients (74 females, mean age 58 years, age range 34–85 years) affected by a pathologically proven intracranial meningioma were retrospectively reviewed. DWI signal intensity of tumors was classified as hypo-, iso- or hyper-intense to grey matter. ADC values and normalised ADCratio (ADCmeningioma/ADCnormal appearing white matter) of the neoplastic tissue (avoiding calcifications and cystic or necrotic areas) were measured by two neuroradiologists unaware of each others’ reading. MRI and histological findings were compared.

Results

Meningiomas were histologically graded as malignant (1%), atypical (21.5%) and benign (77.5%). Meningothelial, transitional and fibrous were the most frequent benign sub-types (44, 16 and 10 cases, respectively). There was no statistical difference between typical and atypical/malignant meningiomas when considering mean ADC values (0.964 ± 0.192 × 10−3 vs 0.923 ± 0.085 × 10−3 cm2/s, p = 0.3 t-Student) or ADCratio (1.266 ± 0.290 vs 1.185 ± 0.115, p = 0.2 t-Student). ADC values or ADCratio did not differ significantly among meningioma sub-types although a nearly significant difference was found between meningothelial and transitional (post hoc analysis p = 0.06). Inter-observer agreement of ADC and ADCratio measurements was high (r = 0.95 and 0.92, respectively, Pearson’s linear coefficient). DWI intensity did not reach a significant correlation with meningioma’s grading (p = 0.08).

Conclusions

According to our study, DWI and ADC measurement do not seem reliable in grading meningiomas or identifying histological sub-types. Hence, these parameters should not be recommended for surgical or treatment planning.

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Acknowledgements

We thank Mr. Valerio Gerunda for his excellent technical support. This work was supported in part by Grant Ricerca Finalizzata 2008 from Regione Veneto to Prof. d’Avella.

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Authors and Affiliations

  1. Department of Neuroradiology, Azienda Ospedaliera Università di Padova, Padova, Italy

    Luca Santelli, Gaetano Ramondo & Renzo Manara

  2. Department of Neurosurgery, Azienda Ospedaliera Università di Padova, Padova, Italy

    Alessandro Della Puppa & Renato Scienza

  3. Academic Neurosurgery, Department of Neurosciences, Azienda Ospedaliera Università di Padova, Padova, Italy

    Mario Ermani & Domenico d’Avella

Authors
  1. Luca Santelli
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  2. Gaetano Ramondo
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  3. Alessandro Della Puppa
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  4. Mario Ermani
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  5. Renato Scienza
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  6. Domenico d’Avella
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  7. Renzo Manara
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Corresponding author

Correspondence to Domenico d’Avella.

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Comments

Rather infrequent atypical meningiomas (WHO grade II) recur more often and more rapidly after a seemingly complete microsurgical removal than the benign ones (I). Rare anaplastic meningiomas (III) are malignant soft tissue sarcomas that kill with rapid recurrences and metastases in a few years. In clinical routine, both seem to pop up as nasty histologic surprises without warning in routine pre-operative T1 and T2 images.

Consequently, the colleagues from Padova studied whether pre-operative DWI and ADC analysis of meningioma tissue (calcification, haemorrhages and necroses excluded) would differentiate 79 benign meningiomas from 22 atypical + one anaplastic ones. They did not—important clinical data though predictable in hindsight. Why would DWI and ADC be sensitive to tens of genomic and signalling pathway changes in grade II and III meningiomas?

Why to indentify at least the rare (1%) anaplastic meningiomas before first removal? Would the approach change the result? It would not because sarcoma resection with healthy margins cannot be performed. It remains to be seen, however, whether radio/chemotherapy given pre-operatively would prevent microscopic seeding although not effective against visible disease.

Juha E Jääskeläinen

Kuopio, Finland

The authors present a simple, well-crafted and well-written paper about the predictive value of DWI in the histological grading of intracranial meningiomas. Although the concept is not original, the conclusions of the paper help to clarify contradictory data issued from previously related papers. In fact, the study enrolled 102 patients, which is a significant number to avoid sampling errors, and solve the question, raised by this and similar studies. In this regard, Fig. 1 shows a particularly illustrative scatter plot. Most likely, a study on water movements inside the tumours is not the best way to predict the malignancy of a meningioma, starting by the high standard deviation of ADC values obtained from patients, as Table 1 nicely demonstrates.

Although I agree with the concept of extracting an ADC tumour/white matter ratio to overcome institutional differences in the acquisition protocol of the MRI scans, I would criticise in the “Materials and methods” section the concept of variable size ROI. Unfortunately, this introduced another variable to the study besides the main variable in analysis—the meningioma grading—that hinders the scientific rigor.

Oscar Alves

Porto, Portugal

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Santelli, L., Ramondo, G., Della Puppa, A. et al. Diffusion-weighted imaging does not predict histological grading in meningiomas. Acta Neurochir 152, 1315–1319 (2010). https://doi.org/10.1007/s00701-010-0657-y

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  • DOI: https://doi.org/10.1007/s00701-010-0657-y

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