title: Use of Diffusion Weighted Imaging in Differentiating Between Maligant and Benign Meningiomas. A Multicenter Analysis.
abstract: BACKGROUND
  Meningioma is the most frequent intracranial tumor and is often an incidental finding on imaging. Some imaging-based scores were suggested for differentiating low- and high-grade meningiomas. The purpose of this work was to compare diffusion-weighted imaging findings of different meningiomas in a large multicenter study by using apparent diffusion coefficient (ADC) values for predicting tumor grade and proliferation potential.
  
  
  METHODS
  Data from 7 radiologic departments were acquired retrospectively. Overall, 389 patients were collected. All meningiomas were investigated by magnetic resonance imaging (1.5-T scanner) by using diffusion-weighted imaging (b values of 0 and 1000 s/mm(2)). The comparison of ADC values was performed by Mann-Whitney U test.
  
  
  RESULTS
  World Health Organization grade I was diagnosed in 271 cases (69.7%), grade II in 103 (26.5%), and grade III in 15 patients (3.9%). Grade I meningiomas showed statistically significant higher ADC values (1.05 ± 0.39 × 10(-3) mm(2)s(-1)) in comparison with grade II (0.77 ± 0.15 × 10(-3) mm(2)s(-1); P = 0.001) and grade III tumors (0.79 ± 0.21 × 10(-3) mm(2)s(-1); P = 0.01). An ADC value of <0.85 × 10(-3) mm(2)s(-1) was determined as the threshold in differentiating between grade I and grade II/III meningiomas (sensitivity, 72.9%; specificity, 73.1%; accuracy, 73.0%). Ki67 was associated with ADC (r = -0.63, P < 0.001). The optimal threshold for the ADC was (less than) 0.85 × 10(-3) mm(2)s(-1) for detecting tumors with high proliferation potential (Ki67 ≥5%).
  
  
  CONCLUSIONS
  The estimated threshold ADC value of 0.85 can differentiate grade I meningioma from grade II and III tumors. The same ADC value is helpful for detecting tumors with high proliferation potential.
authors.affiliation: Department of Radiology, Martin-Luther-University, Halle-Wittenberg, Germany; Department of Diagnostic and Interventional Radiology, University of Leipzig, Leipzig, Germany; University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA. Electronic address: alex.surow@medizin.uni-halle.de.
authors.forename: Alexey
authors.initials: A
authors.lastname: Surov
authors.affiliation: University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA.
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Ginat
authors.affiliation: Department of Radiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey.
authors.forename: Eser
authors.initials: E
authors.lastname: Sanverdi
authors.affiliation: Department of Neuroradiology, National Neuroscience Institute, Singapore.
authors.forename: C C Tchoyoson
authors.initials: CCT
authors.lastname: Lim
authors.affiliation: Department of Radiology, Uludag University School of Medicine, Gorukle, Bursa, Turkey.
authors.forename: Bahattin
authors.initials: B
authors.lastname: Hakyemez
authors.affiliation: Department of Radiology, Graduate School of Medical Science, University of the Ryukyus, Okinawa, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Yogi
authors.affiliation: Servicio de Radiologia, Hospital de Navarra, Pamplona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Cabada
authors.affiliation: Institute of Medical Epidemiology, Biostatistics, and Informatics, Martin-Luther-University, Halle-Wittenberg, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wienke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000473:pathology*; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D038524:Diffusion Magnetic Resonance Imaging / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D038622:Internationality; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology*; D008579:Meningioma / Q000473:pathology*; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: DWI; MRI; Meningioma