Open Access: Higher-Resolution Magnetic Resonance Elastography in Meningiomas to Determine Intratumoral Consistency

Screen Shot 2015-09-25 at 11.43.34 AMBACKGROUND: Magnetic resonance elastography (MRE) analyzes shear wave movement through tissue to determine stiffness. In a prior study, measurements with first-generation brain MRE techniques correlated with intraoperative observations of overall meningioma stiffness.

OBJECTIVE: To evaluate the diagnostic accuracy of a higher-resolution MRE technique to preoperatively detect intratumoral variations compared with surgeon assessment.

METHODS: Fifteen meningiomas in 14 patients underwent MRE. Tumors with regions of distinctly different stiffness were considered heterogeneous. Intratumoral portions were considered hard if there was a significant area ≥6 kPa. A 5-point scale graded intraoperative consistency. A durometer semiquantitatively measured surgical specimen hardness. Statistics included χ2, sensitivity, specificity, positive and negative predicative values, and Spearman rank correlation coefficient.

RESULTS: For MRE and surgery, 9 (60%) and 7 (47%) tumors were homogeneous, 6 (40%) and 8 (53%) tumors were heterogeneous, 6 (40%) and 10 (67%) tumors had hard portions, and 14 (93%) and 12 (80%) tumors had soft portions, respectively. MRE sensitivity, specificity, and positive and negative predictive values were as follows: for heterogeneity, 75%, 100%, 100%, and 87%; for hardness, 60%, 100%, 100%, and 56%; and for softness, 100%, 33%, 86%, and 100%. Overall, 10 tumors (67%) matched well with MRE and intraoperative consistency and correlated between intraoperative observations (P = .02) and durometer readings (P = .03). Tumor size ≤3.5 cm or vascular tumors were more likely to be inconsistent (P < .05).

CONCLUSION: MRE was excellent at ruling in heterogeneity with hard portions but less effective in ruling out heterogeneity and hard portions, particularly in tumors more vascular or <3.5 cm. MRE is the first technology capable of prospectively evaluating intratumoral stiffness and, with further refinement, will likely prove useful in preoperative planning.

From: Higher-Resolution Magnetic Resonance Elastography in Meningiomas to Determine Intratumoral Consistency by Hughes et al.

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