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

Joshua D. Hughes, Nikoo Fattahi, Jamie Van Gompel, Arvin Forghanian-Arani, Fredric Meyer, Giuseppe Lanzino, Michael J. Link, Richard Lorne Ehman, John Huston

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

BACKGROUND: 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 χ 2, 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. ABBREVIATIONS: MRE, magnetic resonance elastography NPV, negative predictive value PPV, positive predictive value ROI, region of interest .

Original languageEnglish (US)
Pages (from-to)653-658
Number of pages6
JournalNeurosurgery
Volume77
Issue number4
DOIs
StatePublished - Oct 21 2015

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Elasticity Imaging Techniques
Meningioma
Neoplasms
Hardness
Blood Vessels
Sensitivity and Specificity
Nonparametric Statistics
Reading

Keywords

  • Consistency
  • Magnetic resonance elastography
  • Meningioma
  • MRE
  • Stiffness

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Higher-Resolution Magnetic Resonance Elastography in Meningiomas to Determine Intratumoral Consistency. / Hughes, Joshua D.; Fattahi, Nikoo; Van Gompel, Jamie; Forghanian-Arani, Arvin; Meyer, Fredric; Lanzino, Giuseppe; Link, Michael J.; Ehman, Richard Lorne; Huston, John.

In: Neurosurgery, Vol. 77, No. 4, 21.10.2015, p. 653-658.

Research output: Contribution to journalArticle

Hughes, Joshua D. ; Fattahi, Nikoo ; Van Gompel, Jamie ; Forghanian-Arani, Arvin ; Meyer, Fredric ; Lanzino, Giuseppe ; Link, Michael J. ; Ehman, Richard Lorne ; Huston, John. / Higher-Resolution Magnetic Resonance Elastography in Meningiomas to Determine Intratumoral Consistency. In: Neurosurgery. 2015 ; Vol. 77, No. 4. pp. 653-658.
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abstract = "BACKGROUND: 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 χ 2, 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. ABBREVIATIONS: MRE, magnetic resonance elastography NPV, negative predictive value PPV, positive predictive value ROI, region of interest .",
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AU - Hughes, Joshua D.

AU - Fattahi, Nikoo

AU - Van Gompel, Jamie

AU - Forghanian-Arani, Arvin

AU - Meyer, Fredric

AU - Lanzino, Giuseppe

AU - Link, Michael J.

AU - Ehman, Richard Lorne

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N2 - BACKGROUND: 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 χ 2, 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. ABBREVIATIONS: MRE, magnetic resonance elastography NPV, negative predictive value PPV, positive predictive value ROI, region of interest .

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KW - Magnetic resonance elastography

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KW - MRE

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