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Computer-aided volumetric analysis as a sensitive tool for the management of incidental meningiomas

  • Clinical Article
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Abstract

Introduction

Meningiomas are typically slow-growing lesions that, depending on the location, can be relatively benign. Knowing their exact rate of growth can be helpful in determining whether surgery is necessary.

Methods

In this study we retrospectively reviewed the meningioma practices of the two senior authors (JR, MR). Our goal was to measure meningioma growth using a variety of methods (linear using diameters, and volumetric using the computer-aided perimeter and cross-sectional diameter methods) to compare rates of growth among the methods. Of 295 meningioma patients seen over an 8-year period, we identified a cohort of 31 patients with at least 30 months of follow-up. Volumes were calculated using medical imaging software with T1 post-contrast magnetic resonance imaging. Doubling times and growth rates were calculated.

Results

Of the 31 patients, 26 (84%) were shown to have growing meningiomas. The perimeter methodology measured higher growth rates than the diameter method for both doubling times as well as percentage annual growth (p < 0.01). The mean doubling time was 13.4 years (range, 2.1–72.8 years) and 17.9 years (range, 4–92.3 years) comparing perimeter and diameter methods, respectively. The mean percentage of annual growth was 15.2% (range, 1.8–61.7%) and 5.6% (range, 0.7–12.2%), comparing perimeter and diameter methods, respectively. Linear growth was calculated at 0.7 mm/year.

Conclusion

Overall, we found that computer-aided perimeter methods showed a more accurate picture of tumor progression than traditional methods, which generally underestimated growth.

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Conflicts of Interest

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Authors and Affiliations

  1. Department of Neurosurgery, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Victor Chang, Rajan Jain, Jack Rock & Mark Rosenblum

  2. Department of Radiology Neuroscience Institute, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Jayang Narang & Rajan Jain

  3. Department of Biostatistics and Research Epidemiology, Henry Ford Health System, 2799 W Grand Blvd, Detroit, MI, 48202, USA

    Lonni Schultz

  4. Department of Neurosurgery, University of Illinois, Peoria, IL, USA

    Ahmad Issawi

Authors
  1. Victor Chang
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  2. Jayang Narang
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  4. Ahmad Issawi
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  5. Rajan Jain
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  6. Jack Rock
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  7. Mark Rosenblum
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Correspondence to Victor Chang.

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Comment

The diameter of a meningioma doubles during MRI follow up - how much did the volume increase ? - correct answer: eight times !

The authors retrospectively reviewed the meningioma practices of two senior US neurosurgeons from 2000 to 2010, and out of the 295 meningioma patients identified 31 whose meningioma had been MR imaged at least twice with a minimum interval of 30 months. They calculated the volumes of the 31 meningiomas from the sequential T1 contrast images, using two methods:

1. Volume of an ovoid object = length x width x height / 2, using maximal cross-sectional diameters from axial images for width and length and coronal images for height.

2. Sum of volumes of each slice (slice area x slice thickness), using a semi-automated, user-assisted tumour volume software.

Then they calculated with both volume values:

a. Tumour volume doubling time = t x log2 / log (Vt / V0), where t is time between the initial volume V0 and the final volume Vt.

b. Tumour diameter growth mm per year, the difference between the final and initial diameters divided by the time interval, with diameter = 2 x volume / 3 from computed volumetry.

They found that the computed volumetry showed a more accurate picture of tumour progression, and that the ovoid object diameter method generally underestimated the growth.

A selection from already selected cases - yes, but that is not the point. Its easy to agree with the authors that the volume growth rate of meningioma - or any other sharply demarcated tumour - is an important factor in determining whether and when the tumour or its remnant should be resected or removed.

We elders are hopelessly diametrical when we scroll MR images at worst in the axial plane and at best in all three planes - even worse when we try to verify the re-growth of irregular remnants of previously resected meningiomas. But the young generation will have advanced 3D visualization and virtual graphics tools for quick comparative volumetry. And when so, it's also easy to conceive that near-future neuroradiology reports include volumes of sharp tumours - also in log volume growth curve plots when sequential imaging is available.

Juha E Jääskeläinen

Kuopio, Finland

Jääskeläinen J, Laasonen E, Kärkkäinen J, Haltia M, Troupp H. Hormone treatment of meningiomas: lack of response to medroxyprogesterone acetate (MPA). A pilot study of five cases. Acta Neurochir 1986;80:35-41

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Chang, V., Narang, J., Schultz, L. et al. Computer-aided volumetric analysis as a sensitive tool for the management of incidental meningiomas. Acta Neurochir 154, 589–597 (2012). https://doi.org/10.1007/s00701-012-1273-9

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  • DOI: https://doi.org/10.1007/s00701-012-1273-9

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