Noncontrast imaging for the surveillance of treated and untreated meningiomas.

IF 3.5 2区 医学 Q1 CLINICAL NEUROLOGY
Lana V Nguyen, Ning M Kam, Simon J Li, Jean Lee, Hamish McKay, Randall Jones, Tom Sutherland, Paul Smith, Andrew J Gogos
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引用次数: 0

Abstract

Objective: Patients with meningiomas require serial MRI for surveillance of tumor size and growth rate. The cost and resource requirements for contrast-enhanced MRI include intravenous cannulation, the contrast agent, risk of adverse reaction, and the time needed to acquire, review, and report the additional sequences. With repeated doses, gadolinium is known to accumulate in neural tissues. The authors compared the correlation and accuracy of axial T2-weighted imaging (T2WI) sequences alone for assessing tumor growth, dimensions, and dural venous sinus invasion compared with the current clinical practice of assessing both contrast-enhanced T1-weighted imaging (CE-T1WI) and T2WI sequences.

Methods: The authors retrospectively identified 136 adult patients (65 patients with treated and 71 patients with untreated meningiomas) with two MRI scans obtained at least 6 months apart. For each patient, the two CE-T1WI sequences separated by time were paired, as were the two T2WI sequences, and assessed independently. The paired scans were assessed by a neuroradiologist and advanced radiology trainee blinded to clinical data. Tumor location, dimensions, growth, and venous invasion were evaluated. Peritumoral edema was assessed on T2WI only. Agreement between assessments on both CE-T1WI and T2WI sequences compared with T2WI alone was evaluated using Cohen's kappa (κ), the intraclass correlation coefficient (ICC), and Bland-Altman plots.

Results: Growth was detected in 36 tumors on T2WI compared with 39 when both CE-T1WI and T2WI were assessed. Growth assessed on T2WI alone showed near-perfect agreement with growth assessed on CE-T1WI and T2WI together (κ = 0.945). T2WI alone had an accuracy of 97.8%, specificity of 100%, and sensitivity of 92.3%. Interrater correlation between the radiologists for tumor dimensions was good to excellent (ICC > 0.843). Intrarater agreement between T2WI and CE-T1WI measurements of anteroposterior and transverse tumor dimensions was good (ICC > 0.883 for observer 1, > 0.767 for observer 2). There was substantial agreement between venous invasion on T2WI and both CE-T1WI and T2WI (κ = 0.771). Subgroup analysis for skull base (58.1%), treated (47.8%), and large (> 20-mm diameter; 38.2%) meningiomas did not show any significant difference in agreement between T2WI only and CE-T1WI and T2WI assessments of growth, venous invasion, or tumor dimension.

Conclusions: In patients with treated and untreated meningiomas, unenhanced T2WI can assess tumor dimensions, detect growth, and detect venous invasion with comparable reliability and accuracy to the current clinical practice of using both CE-T1WI and T2WI.

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来源期刊
Journal of neurosurgery
Journal of neurosurgery 医学-临床神经学
CiteScore
7.20
自引率
7.30%
发文量
1003
审稿时长
1 months
期刊介绍: The Journal of Neurosurgery, Journal of Neurosurgery: Spine, Journal of Neurosurgery: Pediatrics, and Neurosurgical Focus are devoted to the publication of original works relating primarily to neurosurgery, including studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology. The Editors and Editorial Boards encourage submission of clinical and laboratory studies. Other manuscripts accepted for review include technical notes on instruments or equipment that are innovative or useful to clinicians and researchers in the field of neuroscience; papers describing unusual cases; manuscripts on historical persons or events related to neurosurgery; and in Neurosurgical Focus, occasional reviews. Letters to the Editor commenting on articles recently published in the Journal of Neurosurgery, Journal of Neurosurgery: Spine, and Journal of Neurosurgery: Pediatrics are welcome.
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