Predicting critical surgical characteristics of intracranial meningiomas on MRI-A prospective study on 100 consecutive patients.

Abstract

Background: This study aimed to identify magnetic resonance imaging (MRI) markers predictive of essential surgical characteristics in meningiomas, including consistency, ease of dissection of meningioma from surrounding brain tissue, and vascularity, which are crucial for surgical decisions and outcomes.

Methods: We conducted preoperative MRI using a standardized protocol to measure signal intensities (SI) within meningiomas. Additionally, we administered intraoperative questionnaires and performed histological analyses on each tumor.

Results: A total of 100 consecutive patients (mean age, 58 years ± 13, 69 female) were enrolled in this prospective clinical trial. Meningioma volumes varied (0.4-185.6 cm³) with surgeries lasting on average 176 min (range 35-610 min). SI measurements on T1-weighted, time-of-flight (TOF), and T2-weighted imaging were significantly associated with tumor consistency and vascularity. Specifically, the sensitivity and specificity for predicting consistency grades above 3 (on a 1-5 grade scale) were 75% and 55% postcontrast on T1-weighted imaging (SI ≥ 711) and 73% and 70% on TOF imaging (SI ≥ 124.5). For vascularity grades above 5 (on a 1-10 grade scale), the values were 73% sensitivity and 54% specificity on TOF imaging (SI ≥ 123). No correlation was found between the surgical cleavage plane and MRI data; however, dissection plane type significantly influenced surgery duration and hospitalization length. A lower SI on T2-weighted imaging correlated with specific histological features.

Conclusion: Key surgical aspects of meningiomas can be predicted using conventional MRI sequences. This may improve patient counseling and surgical planning.