T2/Flair Characteristics of Meningioma Borders on MRI May Be Associated with Brain Invasion

Background Assessment of preoperative imaging is important for operative planning of meningioma resection. A hyperintense rim on T2-weighted (T2W) MRI is frequently thought to represent a CSF cleft between the tumor and the brain, suggesting a clean arachnoid plane. However, brain invasion (loss of arachnoid plane) is often encountered instead. We sought to further characterize this radiographic finding and identify correlates with intraoperative brain invasion and pathology in patients undergoing meningioma resection.

Methods Retrospective review of 42 patients (mean age: 54.2 years, SD: 13.0, 76% female) who underwent meningioma resection between 2013 and 2016 at a single institution. Demographic variables and pathology results were recorded. Radiographic variables on preoperative MRI included presence and size of a hyperintense rim on T2W MRI, a contrast-enhancing rim on fluid-attenuated inversion recovery (FLAIR), and adjacent edema. Operative reports were reviewed for identification of loss of arachnoid plane (brain invasion) noted during surgery. Radiographic findings were then correlated with brain invasion using nonparametric statistics.

Results Of 42 meningiomas resected, there were 29 (69%) WHO Grade I, 12 (29%) WHO Grade II, and 1 (2%) WHO Grade III. Twenty-three tumors (55%) were located at the skull base. On preoperative T2WI, 36 (86%) of meningiomas demonstrated a hyperintense cleft with a mean width of 2.86 mm (SD: 1.66) and 16 had adjacent edema. Twenty-six meningiomas demonstrated a contrast-enhancing rim on FLAIR with a mean width of 2.85 mm (SD: 1.06) and 28 meningiomas exhibited a rim that was both T2 hyperintense and enhancing on FLAIR. Intraoperatively, 24 (57%) of meningiomas were found to have partial or complete loss of an arachnoid plane between the tumor and adjacent brain parenchyma. Both a hyperintense T2 cleft and enhancing FLAIR rim were associated with loss of arachnoid plane (p = 0.004 for T2, <0.001 for FLAIR, <0.001 for combined).

Conclusion Preoperative MRI of meningiomas often identifies a T2 hyperintense rim frequently thought to represent a CSF cleft. A correlation with enhancement on FLAIR and intraoperative loss of arachnoid plane suggests this may be a useful marker of brain invasion and could aid in operative planning and risk assessment.

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