Noninvasive Differentiation of Meningiomas and Dural Metastases Using Intratumoral Vascularity Obtained by Arterial Spin
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ORIGINAL ARTICLE
Noninvasive Differentiation of Meningiomas and Dural Metastases Using Intratumoral Vascularity Obtained by Arterial Spin Labeling Julia Furtner1,2 · Isabelle Oth1 · Veronika Schöpf3,4 · Karl-Heinz Nenning1 · Ulrika Asenbaum1 · Adelheid Wöhrer2,5 · Ramona Woitek1 · Georg Widhalm2,6 · Barbara Kiesel2,6 · Anna S. Berghoff2,7 · Johannes A. Hainfellner2,5 · Matthias Preusser2,7 · Daniela Prayer1,2 Received: 5 July 2018 / Accepted: 6 June 2019 © The Author(s) 2019
Abstract Purpose Using conventional magnetic resonance imaging (MRI) techniques, the imaging features of meningiomas and dural metastases overlap and a differentiation between these tumor entities therefore remains difficult, particularly in patients with a known primary neoplasm. The purpose of this study was to explore the potential role of normalized vascular intratumoral signal intensity values (nVITS) obtained from pulsed arterial spin labeling (PASL) to differentiate between meningiomas and dural metastases. Methods In this study PASL was performed in 46 patients with meningiomas (n = 30) and dural metastases (n = 16) on a 3T scanner, in addition to the routine diagnostic imaging protocol. The ratio between the vascular signal intensity of the tumor and the contralateral normal white matter obtained by PASL images was defined as nVITS. Results Meningiomas showed significantly higher nVITS values compared to dural metastases (p < 0.001). The optimal nVITS cut-off value to differentiate between the 2 tumor entities was 1.989, with 100% sensitivity and 81.2% specificity. Conclusion The nVITS values obtained by PASL provide a fast and noninvasive MRI technique with which to differentiate between meningiomas and dural metastases in a routine clinical setting based on tumor vascularity.
Keywords Meningioma · Brain metastases · Extra-axial brain tumors · Pulsed arterial spin labeling · Intratumoral neovascularization
Introduction
Julia Furtner
[email protected] 1
Department of Biomedical Imaging and Image-guided Therapy, Central Nervous System Tumor Unit (CCC-CNS), Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
2
Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
3
Institute of Psychology, University of Graz, Universitätsplatz 2, 8010 Graz, Austria
4
BioTechMed, Mozartgasse 12, 8010 Graz, Austria
5
Institute of Neurology, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
6
Department of Neurosurgery, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
7
Department of Medicine I, Medical University of Vienna, Währinger Gürtel 18–20, 1090 Vienna, Austria
Meningiomas are the most common primary intracranial tumors in adults, representing approximately one third of all intracranial neoplasms [1, 2]. They arise from meningothelial cells of the arachnoid and present as avid, homogeneous, contrast-enhancing dural masses on computed tomography (CT) and magnetic resonance imaging (MRI) [3]. Dur
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