title: MRI Pre- and Post-Embolization Enhancement Patterns Predict Surgical Outcomes in Intracranial Meningiomas.
abstract: OBJECTIVE
  To evaluate the effects of preoperative embolization on overall surgical outcomes after meningioma resection and determine whether pre- and postembolization tumor enhancement patterns on magnetic resonance imaging (MRI) scans can be used to assess the efficacy of embolization.
  
  
  METHODS
  We developed a prospective database of all patients who underwent surgical resection with or without preoperative embolization for extra-axial intracranial meningiomas from 2004 to 2010. Using specialized computer software, the total volume of enhancement was calculated in pre- and postembolization MRI scans to quantify the percentage of embolization, which was described as the embolization fraction (EF).
  
  
  RESULTS
  A total of 89 patients underwent surgical resection. Fifty two patients underwent embolization prior to surgery. Tumor location significantly correlated with the decision to embolize preoperatively. Adequate embolization was achieved in 58% of patients. Forty four patients (84.6%) had a postsurgical Karnofsky performance score (KPS) of 80 or above, while 46 patients (88.4%) had a postsurgical Glascow Outcome Score (GOS) of 4 or 5. The mean EF was 25.03% with a median of 18.72%. A greater extent of embolization as quantified by EF led to decreased intraoperative blood loss (r = -.319, P = .022) and better postsurgical outcomes as defined by KPS (r = .279, P = .044).
  
  
  CONCLUSIONS
  Pre- and postembolization tumor enhancement patterns on magnetic resonance imaging defined as EF correlate with improved surgical facilitation and postoperative functional outcomes in the management of intracranial meningioma.
authors.affiliation: Departments of Neurosurgery Henry Ford Health System, Detroit, MI, 48202.
authors.forename: Rushna
authors.initials: R
authors.lastname: Ali
authors.affiliation: Department of Neurology, Warren Alpert Medical School, Brown University, Providence, RI.
authors.forename: Muhib
authors.initials: M
authors.lastname: Khan
authors.affiliation: Departments of Neurosurgery Henry Ford Health System, Detroit, MI, 48202.
authors.forename: Victor
authors.initials: V
authors.lastname: Chang
authors.affiliation: Departments of Radiology, Neuroscience Institute, Henry Ford Health System, Detroit, MI, 48202.
authors.forename: Jayant
authors.initials: J
authors.lastname: Narang
authors.affiliation: Division of Neuroradiology, NYU School of Medicine, NYU Langone Medical Center, New York, NY, 10016.
authors.forename: Rajan
authors.initials: R
authors.lastname: Jain
authors.affiliation: Departments of Radiology, Neuroscience Institute, Henry Ford Health System, Detroit, MI, 48202.
authors.forename: Horia
authors.initials: H
authors.lastname: Marin
authors.affiliation: Departments of Neurosurgery Henry Ford Health System, Detroit, MI, 48202.
authors.forename: Jack
authors.initials: J
authors.lastname: Rock
authors.affiliation: Departments of Neurosurgery Henry Ford Health System, Detroit, MI, 48202.
authors.forename: Max
authors.initials: M
authors.lastname: Kole
mesh_terms: D000328:Adult; D000368:Aged; D004621:Embolization, Therapeutic / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Embolization; contrast enhancement; magnetic resonance imaging; meningiomas; outcome