Soni Neetu, Ora Manish, Bathla Girish, Szekeres Denes, Desai Amit, Pillai Jay J, Agarwal Amit
From the Department of Radiology (N.S., J.J.P., A.D., A.A.), Mayo Clinic, Jacksonville, Florida
Department of Nuclear Medicine (M.O.), Sanjay Gandhi Post-Graduate Institute of Medical Sciences, Lucknow, India.
AJNR Am J Neuroradiol. 2025 Feb 3;46(2):240-250. doi: 10.3174/ajnr.A8368.
Meningiomas, the most common primary intracranial neoplasms, account for more than one-third of primary CNS tumors. While traditionally viewed as benign, meningiomas can be associated with considerable morbidity, and specific meningioma subgroups display more aggressive behavior with higher recurrence rates. The risk stratification for recurrence has been primarily associated with the World Health Organization (WHO) histopathologic grade and extent of resection. However, a growing body of literature has highlighted the value of molecular characteristics in assessing recurrence risk. While maintaining the previous classification system, the 5th edition of the 2021 WHO Classification of Central Nervous System tumors (CNS5) book expands upon the molecular information in meningiomas to help guide management. The WHO CNS5 stratifies meningioma into 3 grades (1-3) based on histopathology criteria and molecular profile. The telomerase reverse transcriptase promoter mutations and cyclin-dependent kinase inhibitor 2A/B (/ deletions now signify a grade 3 meningioma with increased recurrence risk. Tumor location also correlates with underlying mutations. Cerebral convexity and most spinal meningiomas carry a 22q deletion and/or NF2 mutations, while skull base meningiomas have , , , and/or mutations. MRI is the primary imaging technique for diagnosing and treatment-planning of meningiomas, while DOTATATE PET imaging offers supplementary information beyond anatomic imaging. Herein, we review the evolving molecular landscape of meningiomas, emphasizing imaging/genetic biomarkers and treatment strategies relevant to neuroradiologists.
脑膜瘤是最常见的原发性颅内肿瘤，占原发性中枢神经系统肿瘤的三分之一以上。虽然传统上被视为良性肿瘤，但脑膜瘤可导致相当高的发病率，并且特定的脑膜瘤亚组表现出更具侵袭性的行为和更高的复发率。复发的风险分层主要与世界卫生组织（WHO）的组织病理学分级和切除范围有关。然而，越来越多的文献强调了分子特征在评估复发风险中的价值。在保留先前分类系统的同时，2021年《世界卫生组织中枢神经系统肿瘤分类》（CNS5）第5版扩展了脑膜瘤的分子信息，以帮助指导治疗。WHO CNS5根据组织病理学标准和分子特征将脑膜瘤分为3级（1-3级）。端粒酶逆转录酶启动子突变和细胞周期蛋白依赖性激酶抑制剂2A/B（/）缺失现在表示复发风险增加的3级脑膜瘤。肿瘤位置也与潜在突变相关。大脑凸面和大多数脊髓脑膜瘤存在22q缺失和/或NF2突变，而颅底脑膜瘤有、、和/或突变。MRI是脑膜瘤诊断和治疗规划的主要成像技术，而DOTATATE PET成像提供了超越解剖成像的补充信息。在此，我们综述了脑膜瘤不断演变的分子格局，重点介绍了与神经放射科医生相关的成像/基因生物标志物和治疗策略。
