Abstract
ObjectivesThe clinical management of meningioma is guided by tumor grade and biological behavior. Currently, the assessment of tumor grade follows surgical resection and histopathologic review. Reliable techniques for pre-operative determination of tumor grade may enhance clinical decision-making.MethodsA total of 175 meningioma patients (103 low-grade and 72 high-grade) with pre-operative contrast-enhanced T1-MRI were included. Fifteen radiomic (quantitative) and 10 semantic (qualitative) features were applied to quantify the imaging phenotype. Area under the curve (AUC) and odd ratios (OR) were computed with multiple-hypothesis correction. Random-forest classifiers were developed and validated on an independent dataset (n = 44).ResultsTwelve radiographic features (eight radiomic and four semantic) were significantly associated with meningioma grade. High-grade tumors exhibited necrosis/hemorrhage (ORsem = 6.6, AUCrad = 0.62–0.68), intratumoral heterogeneity (ORsem = 7.9, AUCrad = 0.65), non-spherical shape (AUCrad = 0.61), and larger volumes (AUCrad = 0.69) compared to low-grade tumors. Radiomic and sematic classifiers could significantly predict meningioma grade (AUCsem = 0.76 and AUCrad = 0.78). Furthermore, combining them increased the classification power (AUCradio = 0.86). Clinical variables alone did not effectively predict tumor grade (AUCclin = 0.65) or show complementary value with imaging data (AUCcomb = 0.84).ConclusionsWe found a strong association between imaging features of meningioma and histopathologic grade, with ready application to clinical management. Combining qualitative and quantitative radiographic features significantly improved classification power.
Highlights
Meningiomas are the most common primary brain tumor in adults, with most considered benign by the World Health Organization histopathologic criteria (WHO grade I)[1,2]
Twelve radiographic features were significantly associated with meningioma grade
We found a strong association between imaging features of meningioma and histopathologic grade, with ready application to clinical management
Summary
Meningiomas are the most common primary brain tumor in adults, with most considered benign by the World Health Organization histopathologic criteria (WHO grade I)[1,2]. Standard-of-care management typically involves surgical resection and often radiation therapy for high-grade (grade II-III) or progressive tumors. The assessment of tumor grade occurs once a mass is resected and histopathological review is performed. Upon detection of a mass lesion that displays radiological features suggestive of meningioma, reliable parameters do not exist that can predict tumor grade and the associated clinical course. Clinical information such as age and gender show poor association with grade. Non-invasive and early predictors of meningioma grade may enhance clinical decision-making by providing prognostic information that could guide the decision of whether to observe or to treat
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