Prediction of high-grade histology and recurrence in meningiomas using routine preoperative magnetic resonance imaging - A systematic review.

Abstract

OBJECTIVE\nEstimating the risk of recurrence after surgery remains crucial during care of meningioma patients. Numerous studies identified correlations of characteristics on routine preoperative MRI with postoperative recurrence or high-grade histology but showed partially inconclusive results.\n\n\nMETHODS\nA systematic review of the literature was performed about findings on preoperative MRI and their correlation with high-grade histology and recurrence. Quality of the included studies was analyzed using standardized QUADAS criteria.\n\n\nRESULTS\nAmong the 35 studies included quality of the series according to the QUADAS criteria differed widely. Remarkably, MRI variables found to be associated with high-grade histology were commonly not consistently associated with prognosis and vice versa. Correlations of the tumor size, the peritumoral edema size and contrast-enhancement of the tumor capsule with high-grade histology were controversial. In most studies, non-skull base tumor location, cyst formation, heterogenous contrast-enhancement, an irregular tumor shape and disruption of the tumor/brain border but not intensity of the lesion on T2-weighted images, calcifications or bone involvement were associated with grade II/III histology. While tumor and edema size were usually found to correlate with recurrence, heterogenous contrast enhancement, cyst formation, intensity of the tumor on T2-weighted MRI and enhancement of the tumor capsule were mostly not related with progression.\n\n\nCONCLUSIONS\nSeveral mostly consistent but partially inconsistent variables associated with high-grade histology or prognosis were identified. Although standardized studies are needed to provide further clarification, consideration of these findings can help to improve estimation of prognosis and can therefore improve postoperative care in meningioma patients.