Distinguishing Grade 1 Meningioma From Higher Grade Meningiomas Without Biopsy


      Many meningiomas are identified radiographically, assumed to be Grade I tumors, and are followed. The purpose of our investigation is to find clinical or radiographic predictors of WHO Grade II/III tumors(Gr II/III) in order to distinguish them from WHO Grade I.


      Patients with a pathologic diagnosis of meningioma from 2002-2009 were included if they had pre-operative MRI studies and pathology for review. Thirty of the 82 tumors were classified as Gr II/III. All pathology was reviewed and classified by WHO 2007. All Brain MRI imaging was reviewed and tumors were assessed for brain invasion, volume, maximum diameter, herniation, apparent diffusion coefficient, necrosis, vascularity (quantified by degree of enhancement, 1-4), associated bleed, and cystic change. Clinical factors analyzed included symptoms, age, sex, medications, smoking status, body mass index (BMI), Charlson comorbidity index, and diabetes. Pathology and Radiology reviews were blinded from each other and from clinical course. Univariate and Multivariate logistic regressions were used to find predictive factors for Gr II/III.


      Univariate analysis demonstrated that the following factors were associated with Gr II/III: Brain Invasion, degree of vascularity, and volume of lesion (at p value < 0.05). Our multivariate logistic model contains predictors of tumor vascularity (p = 0.038, Odds Ratio = 1.83 for unit increase of vascularity), and brain invasion (p = 0.065, Odds Ratio = 2.48). 64% of tumor associated with grade 4 vascularity (n = 17) had a Gr II/III compared to 27.7% of tumors with less vascularity. Brain invasion was seen in 32 patients, 50.0% of which had Gr II/III as compared to 28.3% without brain invasion. A total of 88.8% tumors with both grade 4 vascularity and brain invasion (N = 9) were Gr II/II.


      Tumors without high-grade vascularity and brain invasion are more likely to be Grade I meningiomas. Clinical and radiographic surveillance rather than immediate surgery may be considered for these patients.


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