Higher-Resolution Magnetic Resonance Elastography in Meningiomas to Determine Intratumoral Consistency. Issue 4 (4th July 2015)

• Record Type: Journal Article
• Authors: Hughes, Joshua D.; Fattahi, Nikoo; Van Gompel, J.; Arani, Arvin; Meyer, Fredric; Lanzino, Giuseppe; Link, Michael J.; Ehman, Richard; Huston, John
• Is Part Of: Neurosurgery. Volume 77:Issue 4(2015)
• Page Start: 653
• Page End: 659
• Publication Date: 2015-07-04
• Subjects: Consistency -- Magnetic resonance elastography -- Meningioma -- MRE -- Stiffness; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1227/NEU.0000000000000892
• Languages: English
• ISSNs: 0148-396X

Abstract

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.