Distinguishing grade I meningioma from higher grade meningiomas without biopsy

Oncotarget. 2015 Nov 10;6(35):38421-8. doi: 10.18632/oncotarget.5376.

Abstract

Background: Many meningiomas are identified by imaging and followed, with an assumption that they are WHO Grade I tumors. The purpose of our investigation is to find clinical or imaging predictors of WHO Grade II/III tumors to distinguish them from Grade I meningiomas.

Methods: Patients with a pathologic diagnosis of meningioma from 2002-2009 were included if they had pre-operative MRI studies and pathology for review. A Neuro-Pathologist reviewed and classified all tumors by WHO 2007. All Brain MRI imaging was reviewed by a Neuro-radiologist. Pathology and Radiology reviews were blinded from each other and clinical course. Recursive partitioning was used to create predictive models for identifying meningioma grades.

Results: Factors significantly correlating with a diagnosis of WHO Grade II-III tumors in univariate analysis: prior CVA (p = 0.005), CABG (p = 0.010), paresis (p = 0.008), vascularity index = 4/4: (p = 0.009), convexity vs other (p = 0.014), metabolic syndrome (p = 0.025), non-skull base (p = 0.041) and non-postmenopausal female (p = 0.045). Recursive partitioning analysis identified four categories: 1. prior CVA, 2. vascular index (vi) = 4 (no CVA), 3. premenopausal or male, vi < 4, no CVA. 4. Postmenopausal, vi < 4, no CVA with corresponding rates of 73, 54, 35 and 10% of being Grade II-III meningiomas.

Conclusions: Meningioma patients with prior CVA and those grade 4/4 vascularity are the most likely to have WHO Grade II-III tumors while post-menopausal women without these features are the most likely to have Grade I meningiomas. Further study of the associations of clinical and imaging factors with grade and clinical behavior are needed to better predict behavior of these tumors without biopsy.

Keywords: MRI; cerebrovascular accident; meningioma; tumor vascularity.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Biopsy
  • Child
  • Child, Preschool
  • Diagnosis, Differential
  • Female
  • Humans
  • Magnetic Resonance Imaging*
  • Male
  • Meningeal Neoplasms / etiology
  • Meningeal Neoplasms / pathology*
  • Meningioma / etiology
  • Meningioma / pathology*
  • Middle Aged
  • Neoplasm Grading
  • Postmenopause
  • Predictive Value of Tests
  • Registries
  • Risk Assessment
  • Risk Factors
  • Sex Factors
  • Young Adult