From the Department of Radiology (T.T.), Shizuoka General Hospital, Shizuoka, Japan
Department of Radiology (T.T.), Juntendo University, Tokyo, Japan.
AJNR Am J Neuroradiol. 2021 Jul;42(7):1216-1222. doi: 10.3174/ajnr.A7117. Epub 2021 May 13.
When managing meningiomas, intraoperative tumor consistency and histologic subtype are indispensable factors influencing operative strategy. The purposes of this study were the following: 1) to investigate the correlation between stiffness assessed with MR elastography and perfusion metrics from perfusion CT, 2) to evaluate whether MR elastography and perfusion CT could predict intraoperative tumor consistency, and 3) to explore the predictive value of stiffness and perfusion metrics in distinguishing among histologic subtypes of meningioma.
Mean tumor stiffness and relative perfusion metrics (blood flow, blood volume, and MTT) were calculated (relative to normal brain tissue) for 14 patients with meningiomas who underwent MR elastography and perfusion CT before surgery (cohort 1). Intraoperative tumor consistency was graded by a neurosurgeon in 18 patients (cohort 2, comprising the 14 patients from cohort 1 plus 4 additional patients). The correlation between tumor stiffness and perfusion metrics was evaluated in cohort 1, as was the ability of perfusion metrics to predict intraoperative tumor consistency and discriminate histologic subtypes. Cohort 2 was analyzed for the ability of stiffness to determine intraoperative tumor consistency and histologic subtypes.
The relative MTT was inversely correlated with stiffness (= .006). Tumor stiffness was positively correlated with intraoperative tumor consistency (= .01), while perfusion metrics were not. Relative MTT significantly discriminated transitional meningioma from meningothelial meningioma (= .04), while stiffness did not significantly differentiate any histologic subtypes.
In meningioma, tumor stiffness may be useful to predict intraoperative tumor consistency, while relative MTT may potentially correlate with tumor stiffness and differentiate transitional meningioma from meningothelial meningioma.
在脑膜瘤的治疗中，术中肿瘤硬度和组织学亚型是影响手术策略的不可或缺的因素。本研究的目的如下：1）研究磁共振弹性成像评估的硬度与灌注 CT 的灌注指标之间的相关性，2）评估磁共振弹性成像和灌注 CT 是否可以预测术中肿瘤硬度，3）探讨硬度和灌注指标在鉴别脑膜瘤组织学亚型方面的预测价值。
对 14 例术前接受磁共振弹性成像和灌注 CT 检查的脑膜瘤患者（队列 1）计算平均肿瘤硬度和相对灌注指标（血流量、血容量和 MTT）（相对于正常脑组织）。18 例患者由神经外科医生对术中肿瘤硬度进行分级（队列 2，包括队列 1 的 14 例患者和另外 4 例患者）。在队列 1 中评估肿瘤硬度与灌注指标之间的相关性，以及灌注指标预测术中肿瘤硬度和鉴别组织学亚型的能力。对队列 2 进行分析，以评估硬度确定术中肿瘤硬度和组织学亚型的能力。
相对 MTT 与硬度呈负相关（r= .006）。肿瘤硬度与术中肿瘤硬度呈正相关（r= .01），而灌注指标则无相关性。相对 MTT 可显著区分过渡型脑膜瘤和脑膜上皮型脑膜瘤（P= .04），而硬度则不能显著区分任何组织学亚型。
在脑膜瘤中，肿瘤硬度可能有助于预测术中肿瘤硬度，而相对 MTT 可能与肿瘤硬度相关，并能区分过渡型脑膜瘤和脑膜上皮型脑膜瘤。
