Keita Watanabe, Presenter: Nothing to Disclose

Shingo Kakeda MD, Abstract Co-Author: Nothing to Disclose

Junkoh Yamamoto, Abstract Co-Author: Nothing to Disclose

Norihiro Ohnari, Abstract Co-Author: Nothing to Disclose

Shigeru Nishizawa, Abstract Co-Author: Nothing to Disclose

Yukunori Korogi MD, Abstract Co-Author: Nothing to Disclose

Regarding surgical treatment of meningiomas, the tumor consistency is one of important risks for severe complications. Our purpose is to assess the usefulness of the contrast-enhanced steady-state acquisition (CE-FIESTA) at 3.0T MRI for the prediction of meningioma consistency.

Forty-five consecutive patients with meningiomas undergoing surgery underwent the preoperative MRI including CE-FIESTA and CT. Two neuroradiologists classified the tumors into three groups based on degree of contrast heterogeneity of CE-FIESTA findings [grade 1: negligible, the total area of low intensity component was less than 10% of the whole area, grade 2: mild, 10–30% low intensity component area, grade 3: severe, greater than 30% low intensity component area]. The neuroradiologists also classified the tumors into 3 groups based on degree of bulky calcification at CT [grade 1: negligible, the total area of bulky calcification was less than 10% of the whole area, grade 2: mild, 10-30% of bulky calcification, grade 3: severe, greater than 30% of bulky calcification]. In addition, one neurosurgeon classified intraoperative consistency into 3 groups [soft, moderate, hard]. The χ2 test was used to compare the grade of CE-FIESTA and bulky calcification with the tumor consistency.

The operative findings of the 45 tumors were classified as soft in 7, moderate in 29, and hard in 9. For CE-FIESTA, there was significant positive correlation between consistency of meningiomas and the total area of low intensity components (p<0.05). The CE-FIESTA finding as “grade 3”predicted the hard consistency with the sensitivity of 78% (7 of 9) and specificity of 100% (36 of 36), and accuracy of 96% (43 of 45). For bulky calcification on CT, the grade 3 predicted the hard consistency with sensitivity of 22% (2 of 9) and specificity of 92% (33 of 36), and the accuracy of 78% (41 of 45). Histopathological evaluation revealed that the low intensity component within tumors on CE-FIESTA corresponded to hypovascular, collagen-rich fibrous elements.

CE-FIESTA is useful to predict the consistency of pre-operative meningiomas. On the other hand, severe bulky calcification does not always represent hard meningioma.

Prediction of meningioma consistency using CE-FIESTA is considered to be an important step in preoperative evaluation, because firm consistency of meningioma is a factor that reflects surgical risk.

Watanabe, K, Kakeda, S, Yamamoto, J, Ohnari, N, Nishizawa, S, Korogi, Y, Consistency of Meningiomas: Prediction with CE-FIESTA at 3.0T MRI.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12029505.html