Dynamic susceptibility contrast and dynamic contrast-enhanced MRI characteristics to distinguish microcystic meningiomas from traditional Grade I meningiomas and high-grade gliomas.
OBJECTIVE Microcystic meningioma (MM) is a meningioma variant with a multicystic appearance that may mimic intrinsic primary brain tumors and other nonmeningiomatous tumor types. Dynamic susceptibility contrast (DSC) and dynamic contrast-enhanced (DCE) MRI techniques provide imaging parameters that can differentiate these tumors according to hemodynamic and permeability characteristics with the potential to aid in preoperative identification of tumor type. METHODS The medical data of 18 patients with a histopathological diagnosis of MM were identified through a retrospective review of procedures performed between 2008 and 2012; DSC imaging data were available for 12 patients and DCE imaging data for 6. A subcohort of 12 patients with Grade I meningiomas (i.e., of meningoepithelial subtype) and 54 patients with Grade IV primary gliomas (i.e., astrocytomas) was also included, and all preoperative imaging sequences were analyzed. Clinical variables including patient sex, age, and surgical blood loss were also included in the analysis. Images were acquired at both 1.5 and 3.0 T. The DSC images were acquired at a temporal resolution of either 1500 msec (3.0 T) or 2000 msec (1.5 T). In all cases, parameters including normalized cerebral blood volume (CBV) and transfer coefficient (kTrans) were calculated with region-of-interest analysis of enhancing tumor volume. The normalized CBV and kTrans data from the patient groups were analyzed with 1-way ANOVA, and post hoc statistical comparisons among groups were conducted with the Bonferroni adjustment. RESULTS Preoperative DSC imaging indicated mean (± SD) normalized CBVs of 5.7 ± 2.2 ml for WHO Grade I meningiomas of the meningoepithelial subtype (n = 12), 4.8 ± 1.8 ml for Grade IV astrocytomas (n = 54), and 12.3 ± 3.8 ml for Grade I meningiomas of the MM subtype (n = 12). The normalized CBV measured within the enhancing portion of the tumor was significantly higher in the MM subtype than in typical meningiomas and Grade IV astrocytomas (p < 0.001 for both). Preoperative DCE imaging indicated mean kTrans values of 0.49 ± 0.20 min-1in Grade I meningiomas of the meningoepithelial subtype (n = 12), 0.27 ± 0.12 min-1for Grade IV astrocytomas (n = 54), and 1.35 ± 0.74 min-1for Grade I meningiomas of the MM subtype (n = 6). The kTrans was significantly higher in the MM variants than in the corresponding nonmicrocystic Grade 1 meningiomas and Grade IV astrocytomas (p < 0.001 for both). Intraoperative blood loss tended to increase with increased normalized CBV (R = 0.45, p = 0.085). CONCLUSIONS An enhancing cystic lesion with a normalized CBV greater than 10.3 ml or a kTrans greater than 0.88 min-1should prompt radiologists and surgeons to consider the diagnosis of MM rather than traditional Grade I meningioma or high-grade glioma in planning surgical care. Higher normalized CBVs tend to be associated with increased intraoperative blood loss.
Swedish Neuroscience Institute, Swedish Medical Center, and.
Namath S
NS
Hussain
Swedish Neuroscience Institute, Swedish Medical Center, and.
Marc D
MD
Moisi
Swedish Neuroscience Institute, Swedish Medical Center, and.|Radia Inc. PS, Everett, Washington.
Bart
B
Keogh
Swedish Neuroscience Institute, Swedish Medical Center, and.|Radia Inc. PS, Everett, Washington.
Brendan J
BJ
McCullough
Swedish Neuroscience Institute, Swedish Medical Center, and.|CellNetix Pathology and Laboratories, Seattle; and.
Steven
S
Rostad
Swedish Neuroscience Institute, Swedish Medical Center, and.
David
D
Newell
Swedish Neuroscience Institute, Swedish Medical Center, and.
Ryder
R
Gwinn
Swedish Neuroscience Institute, Swedish Medical Center, and.
Gregory
G
Foltz
Swedish Neuroscience Institute, Swedish Medical Center, and.
Marc
M
Mayberg
Radia Inc. PS, Everett, Washington.
Brian
B
Aguedan
Radia Inc. PS, Everett, Washington.
Valerie
V
Good
Swedish Neuroscience Institute, Swedish Medical Center, and.
Sarah J
SJ
Fouke
D001921:Brain / Q000000981:diagnostic imaging*; D001932:Brain Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005910:Glioma / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology; D008579:Meningioma / Q000000981:diagnostic imaging* / Q000473:pathology; D008875:Middle Aged; D060787:Neoplasm Grading
CBV = cerebral blood volume; DCE = dynamic contrast-enhanced; DSC = dynamic susceptibility contrast; MM = microcystic meningioma; NPV = negative predictive value; PPV = positive predictive value; ROI = region of interest; astrocytoma; dynamic contrast-enhanced MRI; dynamic susceptibility contrast MRI; glioblastoma; glioma; kTrans = transfer coefficient; microcystic meningioma; oncology