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October 2, 2025

Prospective longitudinal study to assess the diagnostic value of the pre-operative brain images in predicting the histopathological grading of meningioma

Key Points

Conventional imaging showed limited predictive value for histopathological grading of meningiomas, undermining diagnostic accuracy.
Advanced imaging techniques like MRS and perfusion were underutilized at only 8.2% and 5.1%, restricting their statistical impact.
The majority of study participants were female, with a mean age of 50.2 years, and most cases exhibited WHO Grade I meningioma.
Preoperative imaging findings correlated poorly with histopathological tumor grades, spotlighting a need for enhanced assessment methods.

Abstract

Background: Meningiomas are the most common benign intracranial tumors, often exhibiting variable radiological and histopathological features. Accurate preoperative prediction of tumor grade remains a diagnostic challenge, despite advances in imaging. Objective: To evaluate the correlation between CT and MRI features and the histopathological grading of surgically managed meningiomas. Methods: This retrospective descriptive study included 98 patients diagnosed with intracranial meningioma who underwent surgical resection at King Saud Medical City between December 2022 and December 2023. Preoperative imaging findings (CT, MRI, MRS, and MR perfusion) were analyzed and correlated with post-operative histopathological grades and subtypes. Results: The majority of patients were females (59.2%) with a mean age of 50.2 years. CT imaging revealed hyperdensity in 44.9% and calcifications in 41.8% of cases. On MRI, most tumors were T1 hypointense (48%) and T2 hyperintense (72.4%), with 59.2% showing restricted diffusion. Peritumoral edema was present in 70.4% of cases. WHO Grade I was the most common histopathological grade (72.4%), and meningothelial meningioma was the predominant subtype (55.1%). Although T2 hyperintensity showed a near-significant correlation with tumor grade (p=0.06), no imaging feature demonstrated a statistically significant correlation with histopathological grade (p>0.05). Advanced imaging techniques like MRS and perfusion were underutilized (8.2% and 5.1%, respectively), limiting their statistical evaluation. Conclusion: Conventional imaging parameters provide valuable anatomical and morphological information but show limited predictive value for histopathological grading. T2 hyperintensity may offer potential as a non-invasive marker, warranting further research. The integration of advanced imaging modalities and molecular profiling could enhance the preoperative assessment of meningiomas and improve prognostication.

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