Abstract
The meta-analysis aimed to compare the preoperative apparent diffusion coefficient (ADC) values between low-grade meningiomas (LGMs) and high-grade meningiomas (HGMs). Medline, Cochrane, Scopus, and Embase databases were screened up to January 2022 for studies investigating the ADC values of meningiomas. The study endpoint was the reported ADC values for LGMs and HGMs. Further subgroup analyses between 1.5T and 3T MRI scanners, ADC threshold values, ADC in different histological LGMs, and correlation coefficients (r) between ADC and Ki-67 were also performed. The quality of studies was evaluated by the quality assessment of diagnostic accuracy studies (QUADAS-2). A χ2-based test of homogeneity was performed using Cochran’s Q statistic and inconsistency index (I2). Twenty-five studies with a total of 1552 meningiomas (1102 LGMs and 450 HGMs) were included. The mean ADC values (×10−3 mm2/s) were 0.92 and 0.79 for LGMs and HGMs, respectively. Compared with LGMs, significantly lower mean ADC values for HGMs were observed with a pooled difference of 0.13 (p < 0.00001). The results were consistent in both 1.5T and 3T MRI scanners. For ADC threshold values, pooled sensitivity of 69%, specificity of 82%, and AUC of 0.84 are obtained for differentiation between LGMs and HGMs. The mean ADC (×10−3 mm2/s) in different histological LGMs ranged from 0.87 to 1.22. Correlation coefficients (r) of mean ADC and Ki-67 ranged from −0.29 to −0.61. Preoperative ADC values are a useful tool for differentiating between LGMs and HGMs. Results of this study provide valuable information for planning treatments in meningiomas.
Highlights
Meningiomas are the most common benign intracranial tumors and account for more than 30% of all brain tumors [1]
Among the 1552 patients, 1102 patients were diagnosed as low-grade meningiomas (LGMs), while 450 patients were diagnosed as highgrade meningiomas (HGMs)
The present meta-analysis showed that preoperative mean apparent diffusion coefficient (ADC) values were significantly lower in HGMs than in LGMs, and the results were consistent for both 1.5T and 3T MRI scanners
Summary
Meningiomas are the most common benign intracranial tumors and account for more than 30% of all brain tumors [1]. Eighty percent of meningiomas are grade I benign meningiomas, referred to as low-grade meningiomas (LGMs); the remaining are grade II atypical meningiomas and grade III malignant meningiomas, referred to as highgrade meningiomas (HGMs) [2]. Most LGMs are slow-growing tumors and usually do not cause clinical symptoms. The HGMs show a higher risk of recurrence and lead to higher morbidity and mortality. The recurrence rates were 14.8%, 49.4%, and 69.7% in grades I, II, and III meningiomas, respectively, and overall 5-year survival was 92% for grade I, 78.5% for grade II, and 44% for grade III meningiomas [3,4]. The treatment planning of meningiomas is highly associated with tumor grading. Surgical resection is considered appropriate for LGMs, whereas adjuvant radiotherapy is recommended for HGMs [5,6]. Correct preoperative prediction of tumor grades for meningiomas is crucial in clinical practice
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