Evaluation of Epidemiologic Factors, Radiographic Features, and Pathologic Findings for Predicting Peritumoral Brain Edema in Meningiomas

Abstract

BackgroundDespite several treatment options that are available for meningiomas, surgery is the only method currently practiced. Peritumoral brain edema (PTBE) in meningiomas causes difficulty marginalizing the dissection in an intraoperative setting.PurposeTo evaluate whether the epidemiological variables, imaging characteristics, and pathologic parameters are correlated with the presence of PTBE in meningiomas.Study TypeRetrospective study from 2015 to 2018.SubjectsIn all, 550 patients with histopathologically confirmed meningioma were included. After exclusion of patients with extradural, spinal, and intraventricular meningiomas and those with image artifacts, a total of 441 patients were included in the final analysis.Field Strength/SequenceImages were performed with 3T MR scanners and axial/sagittal T1WI, axial/coronal T2WI and axial/sagittal/coronal contrast‐enhanced T1WI after administration of 0.1 mmol/kg of body weight of Gd‐DTPA.AssessmentFourteen variables were patients' age, sex, skull changes, calcification, density, location, margin, volume, cerebrospinal fluid (CSF) cleft, signal intensity (SI) on T2WI, degree and pattern of contrast enhancement, WHO histological classification, and Ki‐67 labeling index.Statistical TestsThe relationship between each factor and the formation of PTBE was examined by multivariate logistic regression analysis.ResultsAfter multivariate logistic regression, the absence of CSF cleft (odds ratio [OR]: 63.43, 95% confidence interval [CI]: 27.24–121.42, P = 1.2 × 10−8), non‐skull base location (OR: 15.32, 95% CI: 5.81–28.23, P = 0.0008), high SI on T2WI (OR: 5.05, 95% CI: 2.27–14.88, P = 0.01), and G I uncommon subtypes (OR: 4.75, 95% CI: 1.42–15.94, P = 0.01) were found to be significant independent factors associated with the occurrence of PTBE in meningiomas. In patients with PTBE‐positive meningiomas, there was no significant correlation between the volume of PTBE and the volume of the tumor (r = 0.17, P = 0.60).Data ConclusionThese factors may be suggestive of anticipating the formation of PTBE.Level of Evidence: 3Technical Efficacy Stage: 3J. Magn. Reson. Imaging 2020;52:174–182.

Nomogram Based on MRI Can Preoperatively Predict Brain Invasion in Meningioma

“…The heterogeneous enhancement pattern of meningiomas mostly indicates cyst formation, necrosis, hemorrhage, or intratumoral calci cation. In accordance with previous studies, uneven contrast enhancement was correlated with high-grade histology 29 . In our study, enhanced features were signi cantly different between the two groups.…”

Nomogram based on MRI can preoperatively predict brain invasion in meningioma

“…The heterogeneous enhancement pattern of meningiomas mostly indicates cyst formation, necrosis, or haemorrhage. In accordance with previous studies, uneven contrast enhancement was correlated with high-grade histology [ 29 ]. In our study, enhanced features were significantly different between the two groups.…”

Peritumoral Brain Edema in Meningiomas May Be Related to Glymphatic Dysfunction

“…However, the associations between PTBE extension and tumor volume have been inconsistent. While some studies (Bitzer et al, 1997;Simis et al, 2008) reported positive correlations between PTBE extension and tumor volume, others found no correlations (Paek et al, 2002;Lee et al, 2008;Sapkota et al, 2020;Toh and Castillo, 2021). Some studies attributed frequently found and prominent PTBE in meningiomas with T2 hyperintensity to higher water content (Nakano et al, 2002;Lee et al, 2008;Kim et al, 2011;Sapkota et al, 2020).…”

“…PTBE increases intracranial pressure, complicates surgical resection, and is associated with higher risk of seizures (Simis et al, 2008), postoperative intracranial hemorrhages (Sindou and Alaywan, 1998) and recurrences (Mantle et al, 1999;Simis et al, 2008). Pathogenesis of PTBE remains unclear and there are conflicting reports on correlations between PTBE extension and imaging features such as tumor size or volume (Bitzer et al, 1997;Tamiya et al, 2001;Paek et al, 2002;Lee et al, 2008;Simis et al, 2008;Kim et al, 2011), tumorbrain interface (Tamiya et al, 2001;Nakano et al, 2002;Simis et al, 2008;Kim et al, 2011;Sapkota et al, 2020), tumor location (Osawa et al, 2013;Sapkota et al, 2020), venous outflow obstruction (Kim et al, 2019), tumor blood supply pattern (Tamiya et al, 2001;Osawa et al, 2013), and tumor T2-weighted signal (Tamiya et al, 2001;Nakano et al, 2002;Kim et al, 2011;Sapkota et al, 2020).…”