TY - JOUR
T1 - Higher-Resolution Magnetic Resonance Elastography in Meningiomas to Determine Intratumoral Consistency
AU - Hughes, Joshua D.
AU - Fattahi, Nikoo
AU - Van Gompel, J.
AU - Arani, Arvin
AU - Meyer, Fredric
AU - Lanzino, Giuseppe
AU - Link, Michael J.
AU - Ehman, Richard
AU - Huston, John
N1 - Publisher Copyright:
© 2015 by the Congress of Neurological Surgeons.
PY - 2015/10/21
Y1 - 2015/10/21
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 .
AB - 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 .
KW - Consistency
KW - MRE
KW - Magnetic resonance elastography
KW - Meningioma
KW - Stiffness
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U2 - 10.1227/NEU.0000000000000892
DO - 10.1227/NEU.0000000000000892
M3 - Article
C2 - 26197204
AN - SCOPUS:84941888243
SN - 0148-396X
VL - 77
SP - 653
EP - 658
JO - Neurosurgery
JF - Neurosurgery
IS - 4
ER -