A novel weighted scoring system for estimating the risk of rapid growth in untreated intracranial meningiomas

Restricted access

OBJECTIVE

Advances in neuroimaging techniques have led to the increased detection of asymptomatic intracranial meningiomas (IMs). Despite several studies on the natural history of IMs, a comprehensive evaluation method for estimating the growth potential of these tumors, based on the relative weight of each risk factor, has not been developed. The aim of this study was to develop a weighted scoring system that estimates the risk of rapid tumor growth to aid treatment decision making.

METHODS

The authors performed a retrospective analysis of 232 patients with presumed IM who had been prospectively followed up in the absence of treatment from 1997 to 2013. Tumor volume was measured by imaging at each follow-up visit, and the growth rate was determined by regression analysis. Predictors of rapid tumor growth (defined as ≥ 2 cm3/year) were identified using a logistic regression model; each factor was awarded a score based on its own coefficient value. The probability (P) of rapid tumor growth was estimated using the following formula:

FD1

RESULTS

Fifty-nine tumors (25.4%) showed rapid growth. Tumor size (OR per cm3 1.07, p = 0.000), absence of calcification (OR 3.87, p = 0.004), peritumoral edema (OR 2.74, p = 0.025), and hyperintense or isointense signal on T2-weighted MRI (OR 3.76, p = 0.049) were predictors of tumor growth rate. In the Asan Intracranial Meningioma Scoring System (AIMSS), tumor size was categorized into 3 groups of < 2.5 cm, ≥ 2.5 to < 4.0 cm, and ≥ 4.0 cm in diameter and awarded a score of 0, 3, and 6, respectively; the parameters of calcification and peritumoral edema were categorized into 2 groups based on their presence or absence and given a score of 0 or 2 and 1 or 0, respectively; and the signal on T2-weighted MRI was categorized into 2 groups of hypointense and hyperintense/isointense and given a score of 0 or 2, respectively. The risk of rapid tumor growth was estimated to be < 10% when the total score was 0–2, 10%–50% when the total score was 3–6, and ≥ 50% when the total score was 7–11 (Hosmer-Lemeshow goodness-of-fit test, p = 0.9958). The area under the receiver operating characteristic curve was 0.86.

CONCLUSIONS

The authors suggest a weighted scoring system (AIMSS) that predicts the specific probability of rapid tumor growth for patients with untreated IM. This scoring system will aid treatment decision making in clinical settings by screening out patients at high risk for rapid tumor growth.

ABBREVIATIONS AGR = absolute growth rate; AIMSS = Asan Intracranial Meningioma Scoring System; AUC = area under the receiver operating characteristic curve; CT = computed tomography; IM = intracranial meningioma; RGR = relative growth rate; SI = signal intensity; T2W-MRI = T2-weighted MRI.

Article Information

Correspondence Jeong Hoon, Kim, Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul 05505, Korea. email: jhkim1@amc.seoul.kr.

INCLUDE WHEN CITING Published online January 13, 2017; DOI: 10.3171/2016.9.JNS161669.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Spaghetti plots of tumor volume versus time in the slow-growth (left) and rapid-growth (right) groups. The growth features of the rapid-growth group are in sharp contrast to those of the slow-growth group. Tumors in the rapid-growth group show explosive growth with a mean AGR of 7.3 cm3 per year, whereas most tumors in the slow-growth group are stationary with a mean AGR of 0.4 cm3 per year. Figure is available in color online only.

  • View in gallery

    Tumor growth rates disaggregated by tumor diameter in the slow-growth and rapid-growth groups. In the rapid-growth group, AGR shows a linear increase, and RGR decreases with respect to increasing tumor diameter. However, the AGR and RGR for the slow-growth group are almost static, regardless of any diameter change. This implies that the growth potentials of the 2 groups are quite different. Figure is available in color online only.

  • View in gallery

    Clinical application of the scoring system is presented according to tumor size. The upper row of images in each group shows a patient at low risk for rapid tumor growth, and the lower row of images shows a patient at high risk. FU = follow-up duration; T1CE = T1-weighted contrast-enhanced image.

References

  • 1

    Aguiar PHTsanaclis AMTella OI JrPlese JP: Proliferation rate of intracranial meningiomas as defined by the monoclonal antibody MIB-1: correlation with peritumoural oedema and other clinicoradiological and histological characteristics. Neurosurg Rev 26:2212282003

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 2

    Claus EBBondy MLSchildkraut JMWiemels JLWrensch MBlack PM: Epidemiology of intracranial meningioma. Neurosurgery 57:108810952005

  • 3

    Fathi ARRoelcke U: Meningioma. Curr Neurol Neurosci Rep 13:3372013

  • 4

    Firsching RPFischer APeters RThun FKlug N: Growth rate of incidental meningiomas. J Neurosurg 73:5455471990

  • 5

    Hashiba THashimoto NIzumoto SSuzuki TKagawa NMaruno M: Serial volumetric assessment of the natural history and growth pattern of incidentally discovered meningiomas. J Neurosurg 110:6756842009

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 6

    Hashiba THashimoto NMaruno MIzumoto SSuzuki TKagawa N: Scoring radiologic characteristics to predict proliferative potential in meningiomas. Brain Tumor Pathol 23:49542006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 7

    Hashimoto NRabo CSOkita YKinoshita MKagawa NFujimoto Y: Slower growth of skull base meningiomas compared with non-skull base meningiomas based on volumetric and biological studies. J Neurosurg 116:5745802012

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8

    Jadid KDFeychting MHöijer JHylin SKihlström LMathiesen T: Long-term follow-up of incidentally discovered meningiomas. Acta Neurochir (Wien) 157:2252302015

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Kasuya HKubo OTanaka MAmano KKato KHori T: Clinical and radiological features related to the growth potential of meningioma. Neurosurg Rev 29:2932972006

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    McGovern SLAldape KDMunsell MFMahajan ADe-Monte FWoo SY: A comparison of World Health Organization tumor grades at recurrence in patients with non-skull base and skull base meningiomas. J Neurosurg 112:9259332010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11

    Nakamura MRoser FMichel JJacobs CSamii M: The natural history of incidental meningiomas. Neurosurgery 53:62712003

  • 12

    Nakasu SNakajima MMatsumura KNakasu YHanda J: Meningioma: proliferating potential and clinicoradiological features. Neurosurgery 37:104910551999

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Niiro MYatsushiro KNakamura KKawahara YKuratsu J: Natural history of elderly patients with asymptomatic meningiomas. J Neurol Neurosurg Psychiatry 68:25282000

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Olivero WCLister JRElwood PW: The natural history and growth rate of asymptomatic meningiomas: a review of 60 patients. J Neurosurg 83:2222241995

  • 15

    Ostrom QTGittleman HFulop JLiu MBlanda RKromer C: CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2008–2012. Neuro Oncol 17:Suppl 4iv1iv622015

    • Search Google Scholar
    • Export Citation
  • 16

    Oya SKim SHSade BLee JH: The natural history of intracranial meningiomas. J Neurosurg 114:125012562011

  • 17

    Sughrue MERutkowski MJAranda DBarani IJMcDermott MWParsa AT: Treatment decision making based on the published natural history and growth rate of small meningiomas. J Neurosurg 113:103610422010

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Yano SKuratsu J: Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience. J Neurosurg 105:5385432006

  • 19

    Yoneoka YFujii YTanaka R: Growth of incidental meningiomas. Acta Neurochir (Wien) 142:5075112000

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 82 82 26
Full Text Views 294 294 9
PDF Downloads 331 331 8
EPUB Downloads 0 0 0

PubMed

Google Scholar