Limpastan Kriengsak, Unsrisong Kittisak, Vaniyapong Tanat, Norasetthada Thunya, Watcharasaksilp Wanarak, Jetjumnong Chumpon
Neurosurgery Unit, Clinical Surgical Research Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Asian J Neurosurg. 2022 Dec 10;17(4):614-620. doi: 10.1055/s-0042-1758849. eCollection 2022 Dec.
Consistency of meningiomas is one of the most important factors affecting the completeness of removal and major risks of meningioma surgery. This study used preoperative magnetic resonance imaging (MRI) sequences in single and in combination to predict meningioma consistency. The prospective study included 287 intracranial meningiomas operated on by five attending neurosurgeons at Chiang Mai University Hospital from July 2012 through June 2020. The intraoperative consistency was categorized in four grades according to the method of surgical removal and intensity of ultrasonic aspirator, then correlated with preoperative tumor signal intensity pattern on MRI including T1-weighted image, T2-weighted image (T2WI), fluid-attenuated inversion recovery (FLAIR), and diffusion-weighted image (DWI), which were described as hypointensity, isointensity, and hyperintensity signals which were blindly interpreted by one neuroradiologist. Among 287 patients, 29 were male and 258 female. The ages ranged from 22 to 83 years. A total of 189 tumors were situated in the supratentorial space and 98 were in the middle fossa and infratentorial locations. Note that 125 tumors were found to be of soft consistency (grades 1, 2) and 162 tumors of hard consistency (grades 3, 4). Hyperintensity signals on T2WI, FLAIR, and DWI were significantly associated with soft consistency of meningiomas (relative risk [RR] 2.02, 95% confidence interval [CI] 1.35-3.03, = 0.001, RR 2.19, 95% CI 1.43-3.35, < 0.001, and RR 1.47, 95% CI 1.02-2.11, = 0.037, respectively). Further, chance to be soft consistency significantly increased when two and three hyperintensity signals were combined (RR 2.75, 95% CI 1.62-4.65, ≤ 0.001, RR 2.79, 95% CI 1.58-4.93, < 0.001, respectively). Hypointensity signals on T2WI, FLAIR, and DWI were significantly associated with hard consistency of meningiomas (RR 1.82, 95% CI 1.18-2.81, = 0.007, RR 1.80, 95% CI 1.15-2.83, = 0.010, RR 1.67, 95% CI 1.07-2.59, = 0.023, respectively) and chance to be hard consistency significantly increased when three hypointensity signals were combined (RR 1.82, 95% CI 1.11-2.97, = 0.017). T2WI, FLAIR, and DWI hyperintensity signals of the meningiomas was solely significantly associated with soft consistency and predictive value significantly increased when two and three hyperintensity signals were combined. Each of hypointensity signals on T2WI, FLAIR, and DWI was significantly associated with hard consistency of tumors and tendency to be hard consistency significantly increased when hypointensity was found in all three sequences.
脑膜瘤的质地是影响切除完整性和脑膜瘤手术主要风险的最重要因素之一。本研究使用术前磁共振成像（MRI）序列单独或联合使用来预测脑膜瘤质地。
前瞻性研究纳入了2012年7月至2020年6月在清迈大学医院由五位神经外科主治医生手术治疗的287例颅内脑膜瘤。术中质地根据手术切除方法和超声吸引器强度分为四个等级，然后与术前MRI上肿瘤信号强度模式相关，包括T1加权像、T2加权像（T2WI）、液体衰减反转恢复序列（FLAIR）和扩散加权像（DWI），这些图像被描述为低信号、等信号和高信号，由一位神经放射科医生进行盲法解读。
287例患者中，男性29例，女性258例。年龄范围为22至83岁。总共189个肿瘤位于幕上间隙，98个位于中颅窝和幕下位置。注意，发现125个肿瘤质地柔软（1级、2级），162个肿瘤质地坚硬（3级、4级）。T2WI、FLAIR和DWI上的高信号与脑膜瘤质地柔软显著相关（相对风险[RR]2.02，95%置信区间[CI]1.35 - 3.03，P = 0.001；RR 2.19，95% CI 1.43 - 3.35，P < 0.001；RR 1.47，95% CI 1.02 - 2.11，P = 0.037）。此外，当两个和三个高信号同时出现时，质地柔软的可能性显著增加（RR 2.75，95% CI 1.62 - 4.65，P ≤ 0.001；RR 2.79，95% CI 1.58 - 4.93，P < 0.001）。T2WI、FLAIR和DWI上的低信号与脑膜瘤质地坚硬显著相关（RR 1.82，95% CI 1.18 - 2.81，P = 0.007；RR 1.80，95% CI l.15 - 2.83，P = 0.010；RR 1.67，95% CI 1.07 - 2.59，P = 0.023），当三个低信号同时出现时，质地坚硬的可能性显著增加（RR 1.82，95% CI 1.11 - 2.97，P = 0.017）。
脑膜瘤的T2WI、FLAIR和DWI高信号仅与质地柔软显著相关，当两个和三个高信号同时出现时预测价值显著增加。T2WI、FLAIR和DWI上的每个低信号都与肿瘤质地坚硬显著相关，当在所有三个序列中都发现低信号时，质地坚硬的倾向显著增加。
