Departments of1Radiology and.
2Department of Radiology, Clinical Oncology School of Fujian Medical University, Fujian Cancer Hospital, Fuzhou, China.
J Neurosurg. 2023 Aug 18;140(2):377-385. doi: 10.3171/2023.6.JNS222483. Print 2024 Feb 1.
The general trend in meningioma treatment is shifting from surgery to active surveillance. However, the natural history of meningioma still needs to be clarified, and a simple, practical method is needed to identify fast-growing tumors. The authors aimed to determine whether diffusion-weighted imaging (DWI) could be a valuable imaging modality for predicting meningioma growth.
Consecutive asymptomatic patients with a meningioma diagnosed on MRI and followed up at the authors' institution between July 2011 and July 2019 were eligible for inclusion in this retrospective study. Univariable and multivariable Cox regression analyses were used to explore whether the relative apparent diffusion coefficient (rADC) was an independent predictor of meningioma growth. Correlations between tumor growth rate (TGR), tumor volume doubling time (VDT), Ki-67, and rADC were assessed using the Pearson correlation coefficient. The predictive ability of rADC was evaluated using receiver operating characteristic (ROC) curves and validated with internal validation data.
Sixty-four patients (47 females, 17 males) with a mean age of 62.2 ± 1.4 years were included in this study. Univariable and multivariable analyses revealed that rADC was an independent predictor of meningioma growth (p < 0.05). ROC curve analysis showed that baseline rADC had good predictive power for growing meningiomas (AUC = 0.88, 95% CI 0.78-0.96), as well as slow- or fast-growing meningiomas (AUC = 0.83, 95% CI 0.59-0.98). Moreover, rADC still had a good ability to discriminate between growing and nongrowing meningiomas in the validation set (AUC = 0.85, 95% CI 0.64-1.00). In the 20 patients with tumor growth, baseline rADC was moderately negatively correlated with TGR (r = -0.50, p = 0.02) and strongly positively correlated with VDT (r = 0.63, p = 0.003). Moreover, Ki-67 was significantly associated with rADC in 8 patients who had undergone surgery (r = -0.75, p = 0.03).
In asymptomatic meningiomas, the lower the rADC at baseline, the faster the TGR and the shorter the VDT. DWI could be a valuable tool in predicting meningioma growth in asymptomatic patients.
脑膜瘤治疗的总体趋势正在从手术向主动监测转变。然而，脑膜瘤的自然史仍需阐明，并且需要一种简单实用的方法来识别生长迅速的肿瘤。作者旨在确定弥散加权成像（DWI）是否可作为预测脑膜瘤生长的有价值的影像学方法。
连续纳入 2011 年 7 月至 2019 年 7 月期间在作者所在机构诊断为脑膜瘤且接受随访的连续无症状患者，符合纳入本回顾性研究的条件。使用单变量和多变量 Cox 回归分析来探讨相对表观扩散系数（rADC）是否是脑膜瘤生长的独立预测因子。使用 Pearson 相关系数评估肿瘤生长率（TGR）、肿瘤倍增时间（VDT）、Ki-67 与 rADC 之间的相关性。使用受试者工作特征（ROC）曲线评估 rADC 的预测能力，并使用内部验证数据进行验证。
本研究共纳入 64 例患者（47 例女性，17 例男性），平均年龄为 62.2±1.4 岁。单变量和多变量分析表明，rADC 是脑膜瘤生长的独立预测因子（p<0.05）。ROC 曲线分析显示，基线 rADC 对生长性脑膜瘤具有良好的预测能力（AUC=0.88，95%CI 0.78-0.96），以及生长缓慢或快速的脑膜瘤（AUC=0.83，95%CI 0.59-0.98）。此外，rADC 在验证组中对生长性和非生长性脑膜瘤仍具有良好的区分能力（AUC=0.85，95%CI 0.64-1.00）。在 20 例肿瘤生长的患者中，基线 rADC 与 TGR 呈中度负相关（r=-0.50，p=0.02），与 VDT 呈强正相关（r=0.63，p=0.003）。此外，在 8 例接受手术的患者中，Ki-67 与 rADC 显著相关（r=-0.75，p=0.03）。
在无症状脑膜瘤中，基线时 rADC 越低，TGR 越快，VDT 越短。DWI 可能是预测无症状患者脑膜瘤生长的有价值的工具。
