Introduction: Meningiomas are traditionally classified according to their histologic appearance. There is increasing evidence that meningioma tumorigenesis is associated with genetic alterations in specific gene pathways. Notably, meningiomas linked to similar pathogenic variants show a regional propensity. The correlation between these mutation maps and the spatial distribution of histologic subtypes of meningiomas, however, is still not clarified. The present study aims to determine the spatial profile of the dural attachment zone (DAZ) of different meningioma subtypes.
Methods: Clinical details (e.g. sex), histological features (e.g. meningioma subtypes, WHO grading) and magnetic resonance images features were obtained in 580 treatment-naïve meningioma patients. MR images were normalized to the standardized MNI52 brain template. After semi-automatic tumor segmentation, the DAZ was determined by intersecting the tumor mask with a dura/falx template. Voxel-based lesion mapping (VLSM) was applied to determine the spatial DAZ profile of different meningioma subtypes and WHO grades.
Results: Significant distribution cluster were detected for meningothelial (middle anterior skull base), fibrous/transitional/psammomatous (cerebellar convexity and falx), chordoid (anterior falx), secretory (middle and lateral skull base) and atypic (frontal convexity). WHO grade II meningiomas were clustered at frontal convexity/falx. These patterns aligned with known mutation maps of Hedgehog (meningothelial), NF2 (fibrous/psammomatous/transitional/atypic, high-grade) and SMARCB1 mutations (chordoid).
Conclusion : The present study provides first-time an unbiased, voxel-based description of the spatial profiling of histologic subtypes mimicking the known regional propensity of gene alterations found in meningioma tumorigenesis. This study shows the potential of VLSM in neurooncological research.
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