Introduction: While several studies have explored associations between MRI findings and WHO histopathological grades in meningiomas, the role of initial non-contrast CT imaging in predicting tumor grade remains underexplored. This study aims to identify radiographic and clinical factors from initial CT imaging associated with tumor grade in patients with intracranial or spinal meningiomas.
Methods: We performed a retrospective chart review of patients with a histopathologic-confirmed diagnosis of intracranial or spinal meningiomas operated at our center between 2017 and 2021. CT and MRI radiographic findings including tumor size, side, supratentorial location, intracranial vs spine location, skull-base location, convexity origin, invasion of superior cavernous sinus (SSS), intraventricular origin, along with other clinical and demographic data were recorded. Data were analyzed using parametric tests. Significant prognostic factors in univariable analysis were selected to be included in a stepwise multivariable logistic regression. ROC curve was used to test the discriminative capacity of the model.
Results: Final analysis included 227 patients with grade 1 (74.4%), 2 (25.1%) and 3 (0.4%) meningiomas. Larger tumor size, supratentorial location, and invasion of SSS location were found to be risk factors for higher tumor grade, while skull-base and spine locations were considered protective factors. Multivariable analysis showed that tumor size larger than 33 mm (OR 6.2, P< 0.001) and invasion of SSS (OR 2.8, P=0.007) were strong and independent predictors of higher tumor grade and clinical outcome, regardless of the initial neurologic examination result. The AUC was 0.787 (CI 95=0.72 – 0.85), p< 0.001.
Conclusion : Larger tumor size and SSS invasion are strong and independent risk factors for higher tumor grade in intracranial and spinal meningiomas. Recognizing these predictors underscores the utility of non-contrast CT for valuable counseling insights, even when MRI is unavailable.
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