CORRELATION BETWEEN IMAGISTIC AND PATHOLOGIC FINDNGS IN CEREBRAL

MENINGIOMA

First author: Laura Maria Frîncu Coordinator: Prof. Dr. Mircea Buruian

Second author: Dr. Mihaela A. Dobra Adelina Mãcesanu

Marisiensis 2015

meningioma

is a tumor that arises from the meninges

the most common intracranial primary neoplasm in adults (13-25%)

higher incidence among women as compared to men (2:1)

symptomatic/asymptomatic mean age ranges

between 56-65 years old

Michelle Stafford  Actress on the soap opera “ The young and the restless”

Elizabeth Taylor Academy– award winning actor, star of numerous movies

Sheryl Crow Singer, diagnosed with meningioma in 2012

Felix Plater

1614

Harvey Cushing 1922

Nowadays

correlations between specific preoperative

IMAGING FEATURES and the

PATHOLOGICAL GRADE in patients with meningiomas

Aim:

MATERIAL AND METHODS

retrospective study

289 patients

2009-2013

histopathological examination

WHO classification

surgical treatment

CT and MRI

scans

All data were analyzed with Microsoft Excel, SPSS, GraphPad- Chi-squared test

SPSS

EXCEL

%

women

men

transitional

edema

transitional

11.4%

80.9%

atypical

7.6%

24-83

ANALASTIC

82%

15,3

2%

meningioma

59%41%

womenmen

Gender distribution

Age distribution

WHO Grade I — Benign

WHO Grade II — Atypical

WHO Grade III — Malignant

Meningothelial Chordoid Papillary

Fibrous ( fibroblastic) Clear cell Rhabdoid

Transitional (mixed) Atypical Anaplastic

Psammomatous

Angiomatous

Microcystic

Secretory

Lymphoplasmacyte

Metaplastic

World Health Organization (WHO) Meningioma Classifications

81%

8% 11%

WHO Grade I WHO Grade II WHO Grade III

Distribution by histopathological grade

18%

16%

59%

7%

Column1

Meningothelial

Fibrous

Transitional

Other

Distribution by histopathological type in benign tumors

32%

19%9%

32%8%

Column1

AtypicalPapillaryRhabdoidAnaplasticOther

Distribution by histopathological type in atypical and malignant tumors

Imaging findings observed

INDISTINCT TUMOR BORDERS

HYPEROSTOSIS

EXTRACRANIAL TUMOR EXTENSION

HETEROGENEOUS TUMOR ENHANCEMENT

EDEMA

CAPSULAR ENHACEMENT

Benign Malignant0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%

Edema (p= 0,516)

Capsular enhancement (p=0,11)

Extracranial tumor extension (p=0,384)

Hyperostosis (p< 0.01)

Heterogeneous tumor enhancement( p<0,01)

Indinstinct tumor borders (p< 0,01)

Imaging findings in benign and malignant meningiomas

Axial T2WI MR shows: mass attached by a broad base to the falx (white arrow), with associated perifocal edema (white opened arrow

Axial T1WI MR with contrast shows heterogeneous enhancement, with small areas of hyposignal included in the lesion

Coronal T1WI +C MR shows a mass localized on the bases of the anterior fossa, which presents:

- capsular enhancement- heterogeneous signal, with areas of -hyposignal included characteristic for calcification- Hyperostosis of the sphenoidal bone

Axial NECT with bone window shows a heterogeneous mass adjacent to the left inner parietal table of the skull, with extended calcifications included (white arrow), and associated marked hyperostosis of the skull (open arrow)

Conclusions

Indistinct borders , heterogeneous tumor enhancement and hyperostosis – significantly associated with advanced histopathological grade

Imaging features may lead to noninvasive differentiation between benign and atypical or malignant tumors

Imaging evaluation can provide useful information in preoperative diagnosis and therapeutic strategy

1

2

3

Limitations

Directions

for future research&

•Dust•Dark

Retrospective Prospective

•Improved follow up•Better use of time•Objective

•Mold•TIME•Subjective

1. Abbott K.H., Courville C.B. – Historical notes of the meningiomas, I.A. study of hyperostosis in prehistoric skulls, Bull Los Angeles Neurol Soc., 1939, I4:101-1132.Cushing H., Eisenhardt L.- Meningiomas: Their Classification, Regional Behaviour, Life 2. History ansd Surgical End Results, Springfield, IL: Charles C Thomas, 1938Moodie R.L- Tumors of the head among pre-Columbian Peruvians, Ann Med Hist, 1926, 8:394-4123. Wang H., Lanzino G., Laws E.R.J.- Meningioma: the soul of neurosurgery:historical review, Sem Neurosurg, 2003, 14:163-1684. Netsky M.G.- The first account of a meningioma, Bull Hist Med, 196, 30: 465-468Al- Rodhan N.R., Laws E.R.J.- Meningioma: a historical study of the tumor and its surgical management, 1990, 26:832-8465. Al- Rodhan N.R., Laws E.R.J.- Meningioma: a historical study of the tumor and its surgical management. In: Al-Meftey O., Raven press, New York, 1991:1-8Louis A.- Mémoire sur les Tumeures Fongueuses de la dure-mère, Mem Acad R Chir, Paris, 1774, 5:1-596. Cushing H.- The meningiomas( dural endothelomas): their source, and favored seats of origin, Brain, 1922, 45: 282-3167. Bondy M., Ligon BL.- Epidemiology and etiology of intracranial meningiomas: A review, J neurooncol, 1996, 29: 197-205

Bibliography

Thank you for your attention!