Objective and quantitative evaluation of angiographic vascularity in meningioma: parameters of dynamic susceptibility co
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ORIGINAL ARTICLE
Objective and quantitative evaluation of angiographic vascularity in meningioma: parameters of dynamic susceptibility contrast-perfusion-weighted imaging as clinical indicators of preoperative embolization Kazuhide Adachi 1 & Kazuhiro Murayama 2 & Motoharu Hayakawa 1 & Mitsuhiro Hasegawa 1 & Jun Muto 1 & Yuya Nishiyama 1 & Shigeo Ohba 1 & Yuichi Hirose 1 Received: 22 July 2020 / Revised: 1 October 2020 / Accepted: 30 October 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Digital subtraction angiography (DSA) assesses the necessity of preoperative embolization in meningioma cases but entails complication risks. Previous studies evaluating meningiomas’ angiographic vascularity using perfusion-weighted imaging (PWI) have performed subjective visual assessments, not managing to assess the need for preoperative embolization. We objectively assessed the angiographic stain of meningiomas and examined the usefulness of two parameters of dynamic susceptibility contrast (DSC)-PWI, normalized cerebral blood volume (nCBV) and cerebral blood flow (nCBF), in predicting vascularity and the necessity of preoperative embolization. We retrospectively examined 52 patients who underwent surgery for primary meningioma and preoperative DSA and DSC-PWI. We calculated the normalized luminance (nLum) of the tumor stain in DSA. In 29 meningioma cases with a single feeding artery, we determined the DSC-PWI parameter that correlated with meningioma angiographic vascularity and predicted the necessity of preoperative embolization. We also compared vascularity between meningiomas with single and multiple feeding arteries and between convexity and skull-base meningiomas. nCBF (cut off: 3.66, P = 0.03, area under the curve [AUC] = 0.80) alone could predict the necessity of preoperative embolization and was more significantly correlated with the nLum than nCBV (P = 0.08, AUC = 0.73). Vascularity did not differ between meningiomas with single and multiple feeding arteries; skull-base meningiomas were more vascularized than convexity meningiomas (P = 0.0027). Our objective, quantitative assessments revealed nCBF as the most suitable parameter for evaluating meningioma vascularity. Tumor vascularity assessment using nCBF values and CBF images may aid predicting the necessity of preoperative DSA. Keywords Angiography . Meningioma: MR perfusion . Preoperative embolization . Vascularity
Introduction Predicting the necessity of preoperative embolization is an important role of preoperative digital subtraction angiography (DSA); however, DSA is associated with the risk of neurological complications, e.g., cerebral infarction (0.07–1.3%). [8, 9,
* Kazuhide Adachi [email protected] 1
Department of Neurosurgery, School of Medicine, Fujita Health University, 1-98, Kutsugake Dengakugakubo, Toyoake City, Aichi 470-1192, Japan
2
Joint Research Laboratory of Advanced Medical Imaging, School of Medicine, Fujita Health University, Toyoake City, Aichi, Japan
11, 19, 22] Although three-dimensional computed
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