Department of Radiation Oncology; Department of Medical Oncology; Department of Surgery, Division of Neurosurgery; Department of Medicine, Division of Hematology/Oncology
Neoplasms | Neurology | Oncology | Radiology
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.
MRI, cerebrovascular accident, meningioma, tumor vascularity
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DOI of Published Version
Oncotarget. 2015 Nov 10;6(35):38421-8. doi: 10.18632/oncotarget.5376. Link to article on publisher's site
Varlotto, John; Flickinger, John; Pavelic, Martin T.; Specht, Charles S.; Sheehan, Jonas M.; Timek, Dana T.; Glantz, Michael J.; Sogge, Steven; Dimaio, Christopher; Moser, Richard P.; Yunus, Shakeeb; Fitzgerald, Thomas J.; Upadhyay, Urvashi; Rava, Paul; Tangel, Matthew; Yao, Aaron; and Kanekar, Sangam, "Distinguishing grade I meningioma from higher grade meningiomas without biopsy" (2015). Open Access Articles. 2590.
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This work is licensed under a Creative Commons Attribution 3.0 License.