Radiographic differentiation of secretory meningiomas and WHO grade 2 meningiomas: when atypical features are not always predictive of atypical tumors

• Published in: World neurosurgery Vol. 165; pp. e386 - e392
• Main Authors: Trivedi, Megh M., Momin, Arbaz A., Shao, Jianning, Soni, Pranay, Almeida, Joao Paulo, Lee, Jonathan, Recinos, Pablo F., Kshettry, Varun R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2022
• Subjects: ADC; brain edema; Brain Edema - diagnostic imaging; Brain Edema - etiology; Brain Edema - pathology; brain tumor; Child; Diffusion Magnetic Resonance Imaging - methods; high-grade; Humans; Magnetic Resonance Imaging - methods; Meningeal Neoplasms - complications; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - surgery; Meningioma - complications; Meningioma - diagnostic imaging; Meningioma - surgery; MRI; Retrospective Studies; World Health Organization; ADC; nADC; brain edema; PTBE; G2M; OR; MRI; brain tumor; EMR; FLAIR; SM; high-grade; WHO; Brain tumor; High-grade; Brain edema
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2022.06.061

Secretory meningioma (SM) is a rare subtype of World Health Organization (WHO) grade 1 meningioma, associated with significant peritumoral brain edema (PTBE). Because of this, SM may be mistaken preoperatively to be a WHO grade 2 meningioma (G2M). In this study, we identified radiographic features to differentiate these two tumor types preoperatively to help inform surgical decision-making. We performed a retrospective review of all patients with histologically confirmed intracranial SM and G2M at a single institution from 2000 to 2019. Relevant clinic, demographic and radiographic data were collected. We performed a stepwise multivariable logistic regression to identify independent predictors of SM. A total of 43 SM and 140 G2M patients were included in this study. In multivariable analysis, severe peritumoral brain edema (PTBE) meaning edema size greater than tumor size (OR 4.44, p=0.01), tumor hyperintensity on fluid-attenuated inversion recovery (FLAIR) MRI sequences (OR 7.80, p=0.002), and higher normalized apparent diffusion coefficient (nADC) values (OR 1.54, p<0.001) were strong predictors of SM. Conversely, larger tumor volume (OR 1.79 per 10 cc volume increase, p<0.001) and cystic component (OR 12.50, p=0.007) correlated with G2M. In this study, we found that preoperative FLAIR hyperintensity, severe PTBE, and higher nADC values correlated of SM pathology, and larger size and cystic component were associated with G2M. Accurate identification of SM on preoperative imaging may provide surgeons useful information in decision making.