From the Departments of Radiology and Biomedical Imaging (J.D.B., J.E.V.-M.).
Radiation Oncology (W.C.C., J.S.P., J.H.H., D.R.R.).
AJNR Am J Neuroradiol. 2019 Mar;40(3):433-439. doi: 10.3174/ajnr.A5996. Epub 2019 Feb 28.
BACKGROUND AND PURPOSE: Chordoid meningiomas are uncommon WHO grade II primary intracranial neoplasms that possess unique chordoid histology and follow an aggressive clinical course. Our aim was to assess the utility of qualitative MR imaging features and quantitative apparent diffusion coefficient values as distinguishing preoperative MR imaging metrics to identify and differentiate chordoid histology from other meningioma histologic subtypes. MATERIALS AND METHODS: Twenty-one patients with meningiomas with chordoid histology, which included both chordoid meningiomas (>50% chordoid histology) and meningiomas with focal chordoid histology (<50% chordoid histology) with available preoperative MR imaging examinations, including diffusion-weighted imaging, were identified. Qualitative imaging features and quantitative ADC values were compared between meningiomas with chordoid histology and 42 nonchordoid meningiomas (29 WHO grade I, eleven WHO grade II, and 2 WHO grade III). RESULTS: The median ADC (10mm/s) of meningiomas with chordoid histology was significantly higher than nonchordoid meningiomas (1.16 versus 0.92, < .001), as was the median normalized ADC (1.60 versus 1.19, < .001). In subgroup analysis, the median and normalized ADC values of chordoid meningiomas ( = 11) were significantly higher than those in meningiomas with focal chordoid histology ( = 10, < .001 and < .001, respectively) or nonchordoid meningiomas ( = 42, < .001 and <0.001, respectively). Median and normalized ADC values were not significantly different between the meningiomas with focal chordoid histology and nonchordoid meningiomas ( = .816 and .301, respectively). Among the qualitative imaging features, only DWI signal intensity was significantly associated with meningiomas with chordoid histology diagnosis. CONCLUSIONS: ADC values are higher in chordoid compared with nonchordoid meningiomas and may be used to discriminate the degree of chordoid histology in meningiomas. While qualitative MR imaging features do not strongly discriminate chordoid from nonchordoid meningiomas, DWI may allow preoperative identification of chordoid meningiomas.
背景与目的：脊索样脑膜瘤是一种少见的 WHO 分级 II 级原发性颅内肿瘤，具有独特的脊索样组织学特征，并呈现侵袭性的临床病程。我们的目的是评估定性磁共振成像特征和定量表观扩散系数值作为术前磁共振成像指标的效用，以识别和区分脊索样组织学与其他脑膜瘤组织学亚型。
材料与方法：共确定了 21 例具有脊索样组织学特征的脑膜瘤患者，包括具有大量脊索样组织学特征（>50%脊索样组织学特征）的脊索样脑膜瘤和具有局灶性脊索样组织学特征（<50%脊索样组织学特征）的脑膜瘤，这些患者均具有可用的术前磁共振成像检查，包括弥散加权成像。比较了脊索样脑膜瘤和 42 例非脊索样脑膜瘤（29 例 WHO 分级 I、11 例 WHO 分级 II、2 例 WHO 分级 III）之间的定性成像特征和定量 ADC 值。
结果：脊索样脑膜瘤的平均 ADC（10mm/s）明显高于非脊索样脑膜瘤（1.16 比 0.92，<.001），标准化 ADC 平均值（1.60 比 1.19，<.001）也是如此。在亚组分析中，11 例脊索样脑膜瘤的平均 ADC 和标准化 ADC 值明显高于 10 例具有局灶性脊索样组织学特征的脑膜瘤（<.001 和<.001）或 42 例非脊索样脑膜瘤（<.001 和<.001）。具有局灶性脊索样组织学特征的脑膜瘤和非脊索样脑膜瘤的平均 ADC 和标准化 ADC 值之间无显著差异（分别为.816 和.301）。在定性成像特征中，只有弥散加权成像信号强度与脊索样脑膜瘤的诊断显著相关。
结论：与非脊索样脑膜瘤相比，脊索样脑膜瘤的 ADC 值较高，可用于区分脑膜瘤的脊索样组织学程度。虽然定性磁共振成像特征不能强烈区分脊索样与非脊索样脑膜瘤，但弥散加权成像可能允许术前识别脊索样脑膜瘤。
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