Prediction of the consistency of intracranial meningioma by MRI: Correlation with peroperative finding

Open Access

Abstract

Background: Meningiomas constitute 13-26% of primary intracranial tumors and commonly occur in the fourth to sixth decades of life, with a female-to-male ratio of approximately 1.8:1. Preoperative prediction of tumor consistency aids neurosurgeons in planning the surgical approach and anticipating technical challenges. The aim of this study was to evaluate the correlation between T2-weighted MRI signal intensity and the peroperative consistency of intracranial meningiomas. Methods & Materials: This study involved 31 patients with MRI-confirmed intracranial meningiomas. T2-weighted MRI signal intensity was categorized as isointense, hypointense, or hyperintense compared to cortical gray matter, with hyperintense tumors predicted as soft and iso-/hypointense tumors as firm. Intraoperative tumor consistency was classified as soft or firm based on surgical handling. The study assessed correlation, agreement, and diagnostic performance of MRI in predicting tumor consistency. Results: T2-weighted MRI showed 18 isointense, 1 hypointense, and 12 hyperintense tumors. Peroperatively, 19 tumors were firm and 12 softs. Iso/hypointense tumors predicted as firm were confirmed in 17/19 cases, while 10/12 hyperintense tumors predicted as soft were confirmed. Correlation between MRI signal intensity and tumor consistency was significant (p < 0.001). Agreement analysis showed a Kappa value of 0.6 (fair agreement). For predicting firm tumors, MRI sensitivity was 90%, specificity 83.3%, positive predictive value 89.5%, negative predictive value 83.3%, and accuracy 87%. For soft tumors, sensitivity was 83.3%, specificity 89.5%, PPV 83.3%, NPV 89.5%, and accuracy 87%. Conclusion: T2-weighted MRI can reliably predict meningioma consistency, with hyperintense tumors likely soft and iso- or hypointense tumors likely firm, aiding preoperative surgical planning.