title: Distinguishing grade I meningioma from higher grade meningiomas without biopsy.
abstract: BACKGROUND
  Many meningiomas are identified by imaging and followed, with an assumption that they are WHO Grade I tumors. The purpose of our investigation is to find clinical or imaging predictors of WHO Grade II/III tumors to distinguish them from Grade I meningiomas.
  
  
  METHODS
  Patients with a pathologic diagnosis of meningioma from 2002-2009 were included if they had pre-operative MRI studies and pathology for review. A Neuro-Pathologist reviewed and classified all tumors by WHO 2007. All Brain MRI imaging was reviewed by a Neuro-radiologist. Pathology and Radiology reviews were blinded from each other and clinical course. Recursive partitioning was used to create predictive models for identifying meningioma grades.
  
  
  RESULTS
  Factors significantly correlating with a diagnosis of WHO Grade II-III tumors in univariate analysis: prior CVA (p = 0.005), CABG (p = 0.010), paresis (p = 0.008), vascularity index = 4/4: (p = 0.009), convexity vs other (p = 0.014), metabolic syndrome (p = 0.025), non-skull base (p = 0.041) and non-postmenopausal female (p = 0.045). Recursive partitioning analysis identified four categories: 1. prior CVA, 2. vascular index (vi) = 4 (no CVA), 3. premenopausal or male, vi < 4, no CVA. 4. Postmenopausal, vi < 4, no CVA with corresponding rates of 73, 54, 35 and 10% of being Grade II-III meningiomas.
  
  
  CONCLUSIONS
  Meningioma patients with prior CVA and those grade 4/4 vascularity are the most likely to have WHO Grade II-III tumors while post-menopausal women without these features are the most likely to have Grade I meningiomas. Further study of the associations of clinical and imaging factors with grade and clinical behavior are needed to better predict behavior of these tumors without biopsy.
authors.affiliation: Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Varlotto
authors.affiliation: Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: John
authors.initials: J
authors.lastname: Flickinger
authors.affiliation: Department of Anesthesia, Columbia University Medical Center, New York, NY, USA.
authors.forename: Martin T
authors.initials: MT
authors.lastname: Pavelic
authors.affiliation: Department of Pathology, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Charles S
authors.initials: CS
authors.lastname: Specht
authors.affiliation: Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, USA.|Penn State Hershey Neuroscience Institute, Hershey, PA, USA.
authors.forename: Jonas M
authors.initials: JM
authors.lastname: Sheehan
authors.affiliation: Department of Pathology, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Dana T
authors.initials: DT
authors.lastname: Timek
authors.affiliation: Department of Neurosurgery, Penn State Hershey Medical Center, Hershey, PA, USA.|Penn State Hershey Neuroscience Institute, Hershey, PA, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Glantz
authors.affiliation: Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Sogge
authors.affiliation: Department of Neurology, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Dimaio
authors.affiliation: Division of Neurosurgery, University of Massachusetts Medical Center, Worcester, MA, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Moser
authors.affiliation: Department of Medical Oncology, University of Massachusetts Medical Center, Worcester, MA, USA.
authors.forename: Shakeeb
authors.initials: S
authors.lastname: Yunus
authors.affiliation: Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Fitzgerald
authors.affiliation: Division of Neurosurgery, University of Massachusetts Medical Center, Worcester, MA, USA.
authors.forename: Urvashi
authors.initials: U
authors.lastname: Upadhyay
authors.affiliation: Department of Radiation Oncology, University of Massachusetts Medical Center, Worcester, MA, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Rava
authors.affiliation: Penn State College of Medicine, Hershey, PA, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Tangel
authors.affiliation: Department of Healthcare Policy and Research, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Yao
authors.affiliation: Department of Radiology, Penn State Hershey Medical Center, Hershey, PA, USA.
authors.forename: Sangam
authors.initials: S
authors.lastname: Kanekar
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000209:etiology / Q000473:pathology*; D008579:Meningioma / Q000209:etiology / Q000473:pathology*; D008875:Middle Aged; D060787:Neoplasm Grading; D017698:Postmenopause; D011237:Predictive Value of Tests; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D055815:Young Adult
keywords: MRI; cerebrovascular accident; meningioma; tumor vascularity