Şafak Yılmaz BARAN, Süleyman ŞENER, Teyyub HASANAOV, Akin AKAKIN, Özlem YAPICIER ŞAHAN, Mustafa Kemal DEMIR

Visual qualitative evaluation of diffusion-weighted imaging, apparent diffusion coefficient quantification and Ki-67 proliferation index for predicting atypia in surgical meningiomas

Objectives: The goal of this study was to investigate the efficiency of visual qualitative evaluation using diffusion-weighted (DW) imaging, apparent diffusion coefficient (ADC) quantification, and Ki-67 proliferation labeling index in grading intracranial meningiomas and compare the results with our reference standard for histopathology. Methods and Materials: Thirty-five consecutive patients with pathologically confirmed intracranial meningiomas were enrolled in the study. Their conventional magnetic resonance (MR), contrast-enhanced MR and DW images and ADC maps were investigated. Results: Eight patients (23%) had atypical meningioma (5 women and 3 men; mean age: 57.1±15.8 years); 27 (77%) had low-grade-typical meningioma (19 women, 8 men; mean age: 54.3±14.0 years). The most frequent histological subtype was the meningothelial type in both low-grade (37%) and atypical meningiomas (59%). The mean Ki-67 proliferation index for low-grade and atypical meningiomas were 2.31±1.44% (range: 1-5) and 7.37 ± 2.72% (range: 3-10), respectively. Meningiomas with Ki-67 proliferation index higher than 4% (except one) were atypical (P

Görsel kalitatif difüzyon-ağırlıklı görüntüleme incelemesi, açık difüzyon katsayısı kantifikasyonu ve Ki-67 proliferasyon indeksinin cerrahi meningiomlarda atipi tahminindeki yeri

Amaç: Bu çalışmada amacımız, intrakranyal meningiomların görsel kalitatif olarak incelenip, derecelendirilmesinde difüzyon ağırlıklı (DW) görüntüleme, açık difüzyon katsayısı (ADC) kantifikasyonu ve Ki-67 proliferasyon indeksinin referans standart histopatoloji ile karşılaştırıldığında etkinliğini araştırmaktır. Gereç ve Yöntem: Patolojisi meningiom olarak rapor edilmiş toplam 35 hastamızın, konvansiyonel magnetic rezonans (MR) görüntülemeleri, kontrastlı MR görüntülemeleri, DW görüntülemeleri ve ADC haritaları arşivimizden elde edilmiş ve incelenmiştir. Bulgular: Sekiz hastada (%23) atipik (5 kadın ve 3 erkek; ortalama yaş: 57.1±15.8 yıl); 27 hastada ise (%77) düşük dereceli tipik meningiom (19 kadın, 8 erkek; ortalama yaş: 54.3±14.0 yıl) bulundu. En sık rastlanan histolojik alttip meningotelyal (%59) tip idi. Ki-67 proliferasyon indeksi, düşük dereceli ve atipik meningiomlarda sırasıyla %2,31±1,44 (aralık: 1-5) and %7,37 ± 2,72 (aralık: 3-10) olarak saptandı. Görsel kalitatif değerlendirmede, difüzyon kısıtlanması atipik meningiomlarda daha belirgindi (P

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1. Riemenschneider MJ, Perry A, Reifenberger G. Histological classification and molecular genetics of meningiomas. Lancet Neurol 2006;5:1045-54. doi:10.1016/S1474-4422(06)70625-1

2. Park HJ, Kang HC, Kim IH, et al. The role of adjuvant radiotherapy in atypical meningioma. J Neurooncol 2013;115:241-7. doi:10.1007/s11060-013-1219-y

3. Fatima Z, Motosugi U, Waqar AB, et al. Associations among q-space MRI, diffusion-weighted MRI and histopathological parameters in meningiomas. Eur Radiol 2013;23:2258-63. doi:10.1007/s00330-013-2823-0

4. Filippi CG, Edgar MA, Ulug AM, Prowda JC, Heier LA, Zimmerman RD. Appearance of meningiomas on diffusion-weighted images: correlating diffusion constants with histopathologic findings. AJNR Am J Neuroradiol 2001;22:65-72.

5. Hakyemez B, Yildirim N, Gokalp G, Erdogan C, Parlak M. The contribution of diffusion-weighted MR imaging to distinguishing typical from atypical meningiomas. Neuroradiology 2006;48:513-20. doi:10.1007/s00234-006-0094-z

6. Nagar VA, Ye JR, Ng WH, et al. Diffusion-weighted MR imaging: diagnosing atypical or malignant meningiomas and detecting tumor dedifferentiation. AJNR Am J Neuroradiol 2008;29:1147-52. doi:10.3174/ajnr.A0996

7. Santelli L, Ramondo G, Della Puppa A, et al. Diffusion-weighted imaging does not predict histological grading in meningiomas. Acta Neurochir (Wien) 2010;152:1315-9. doi:10.1007/s00701-010-0657-y

8. Sanverdi SE, Ozgen B, Oguz KK, et al. Is diffusion-weighted imaging useful in grading and differentiating histopathological subtypes of meningiomas? Eur J Radiol 2012;81:2389-95. doi:10.1016/j.ejrad.2011.06.031

9. Commins DL, Atkinson RD, Burnett ME. Review of meningioma histopathology. Neurosurg Focus 2007;23:E3. doi:10.3171/FOC-07/10/E3

10. Pavelin S, Becic K, Forempoher G, et al. Expression of Ki-67 and p53 in meningiomas. Neoplasma 2013;60:480-5. doi:10.4149/neo_2013_062

11. Mahmood A, Caccamo DV, Tomecek FJ, Malik GM. Atypical and malignant meningiomas: a clinicopathological review. Neurosurgery 1993;33:955-63.

12. Hsu CC, Pai CY, Kao HW, Hsueh CJ, Hsu WL, Lo CP. Do aggressive imaging features correlate with advanced histopathological grade in meningiomas? J Clin Neurosci 2010;17:584-7. doi:10.1016/j.jocn.2009.09.018 13. Maier H, Ofner D, Hittmair A, Kitz K, Budka H. Classic, atypical, and anaplastic meningioma: three histopathological subtypes of clinical relevance. J Neurosurg 1992; 77:616-23. doi:10.3171/jns.1992.77.4.0616

14. Palma L, Celli P, Franco C, Cervoni L, Cantore G. Long-term prognosis for atypical and malignant meningiomas: a study of 71 surgical cases. J Neurosurg 1997;86:793-800. doi:10.3171/jns.1997.86.5.0793

15. Knopp EA, Cha S, Johnson G, et al. Glial neoplasms: dynamic contrast-enhanced T2*-weighted MR imaging. Radiology 1999;211:791-8. doi:10.1148/radiology.211.3.r99jn46791

16. Le Bihan D, Breton E, Lallemand D, Aubin ML, Vignaud J, Laval-Jeantet M. Separation of diffusion and perfusion in intravoxel incoherent motion MR imaging. Radiology 1988;168:497-505. doi:10.1148/radiology.168.2.3393671

17. Ma C, Xu F, Xiao YD, Paudel R, Sun Y, Xiao EH. Magnetic resonance imaging of intracranial hemangiopericytoma and correlation with pathological findings. Oncol Lett 2014;8:2140-4. doi:10.3892/ol.2014.2503

18. Perry A, Scheithauer BW, Stafford SL, Lohse CM, Wollan PC. “Malignancy” in meningiomas: a clinicopathologic study of 116 patients, with grading implications. Cancer 1999;85:2046-56. 19. Verheggen R, Finkenstaedt M, Bockermann V, Markakis E. Atypical and malignant meningiomas: evaluation of different radiological criteria based on CT and MRI. Acta Neurochir Suppl 1996;65:66-9.

20. Perry A, Louis DN, Scheithauer BW. Meningiomas. In: Louis DN, Ohgaki H, Wiestler OD, eds. WHO Classification of tumors of the central nervous system. Lyon, France:IARC Press, 2007: 164-72.

21. Sasaki M, Yamada K, Watanabe Y, et al. Variability in absolute apparent diffusion coefficient values across different platforms may be substantial: a multivendor, multi-institutional comparison study. Radiology 2008;249:624-30. doi:10.1148/radiol.2492071681

22. Fatima Z, Motosugi U, Hori M, et al. Age-related white matter changes in high b-value q-space diffusion-weighted imaging. Neuroradiology 2013;55:253-9. doi:10.1007/ s00234-012-1099-4

23. Klimas A, Drzazga Z, Kluczewska E, Hartel M. Regional ADC measurements during normal brain aging in the clinical range of b values: a DWI study. Clin Imaging 2013;37:637-44. doi:10.1016/j.clinimag.2013.01.013