Background and purpose

A subset of aggressive meningioma is associated with higher morbidity and requires a different therapeutic management. This subset consists of World Health Organization (WHO) grade II and III meningioma, characterized particularly with microscopic brain invasion. Numerous studies tried to screen aggressive meningioma on pre-operative MRI. The objective of the study was to determine if an advanced shape analysis of supratentorial meningioma outlines could reliably predict WHO II–III grade and histological brain invasion.

Materials and methods

We performed a retrospective analysis for all consecutive patients who underwent surgery for supratentorial histologically-proven meningioma from 2010 to 2018. Pre-operative MRI T1WI contrast enhanced axial, coronal and sagittal slices were collected from 101 patients. Advanced shape analysis including fractal analysis and topological skeleton analysis was performed. Shape analysis parameters were correlated with histopathological WHO grading and brain invasion on surgical pieces.

Results

Shape analysis features such as a low circularity, a low solidity, a high fractal dimension and a high number of skeleton’s branches were significantly correlated with both WHO II–III meningioma and histological brain invasion. Cross-validated regression models including these features were predictive of WHO II–III meningioma and brain invasion with respective AUC of 0.71 and 0.72.

Conclusions

MRI shape analysis provides informative imaging biomarkers to predict high WHO grade and histological brain invasion of supratentorial meningioma. Further prospective studies including the evaluation of a fully-automatized and totally reproducible process are required to confirm the results.

中文翻译：

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先进的 MRI 形状分析作为组织学侵袭性幕上脑膜瘤的预测因子

背景和目的

侵袭性脑膜瘤的一个子集与较高的发病率相关，需要不同的治疗管理。该子集包括世界卫生组织 (WHO) 的 II 级和 III 级脑膜瘤，其特征尤其是显微脑侵袭。许多研究试图在术前 MRI 上筛查侵袭性脑膜瘤。该研究的目的是确定幕上脑膜瘤轮廓的高级形状分析是否可以可靠地预测 WHO II-III 级和组织学脑侵袭。

材料和方法

我们对 2010 年至 2018 年接受幕上组织学证实的脑膜瘤手术的所有连续患者进行了回顾性分析。从 101 名患者中收集了术前 MRI T1WI 对比增强的轴向、冠状和矢状切片。进行了先进的形状分析，包括分形分析和拓扑骨架分析。形状分析参数与组织病理学 WHO 分级和手术片的脑侵袭相关。

结果

形状分析特征，如低圆形度、低密度、高分形维数和大量骨骼分支与 WHO II-III 脑膜瘤和组织学脑侵袭均显着相关。包括这些特征的交叉验证回归模型可预测 WHO II-III 脑膜瘤和脑侵袭，AUC 分别为 0.71 和 0.72。

结论

MRI 形状分析提供了信息丰富的成像生物标志物来预测高 WHO 级别和组织学脑幕上脑膜瘤的侵袭。需要进一步的前瞻性研究，包括对全自动和完全可重复的过程的评估，以确认结果。