Diagnostic accuracy of dynamic contrast-enhanced CT for meningioma subclassification and its role in evaluating tumor vascularity

Dynamic contrast-enhanced computed tomography (DCE-CT) has the potential to provide quantitative information on meningioma vascularity beyond conventional morphologic imaging. This retrospective study included 68 patients with histologically confirmed intracranial meningioma who underwent preoperative DCE-CT between October 2020 and October 2024. Quantitative perfusion parameters, including blood flow (BF), blood volume (BV), mean transit time (MTT), permeability surface area product (PS), time-to-peak enhancement, and arterial arrival time, were extracted from regions of interest drawn in the solid tumor portion and contralateral normal-appearing brain. Perfusion characteristics among histopathological subtypes and the diagnostic performance of these parameters for differentiating atypical (World Health Organization Grade II) from typical (World Health Organization Grade I) meningiomas were evaluated using receiver operating characteristic analysis and multivariable logistic regression. Compared with contralateral brain, meningiomas demonstrated significantly higher BF and BV, increased PS, and prolonged MTT, time-to-peak enhancement, and arterial arrival time, indicating a hypervascular and highly permeable microenvironment. Atypical meningiomas exhibited significantly higher BV, PS, and MTT than typical subtypes. BV, PS, and MTT achieved areas under the curve of 0.86, 0.81, and 0.84, respectively, for identifying atypical lesions, while a combined model incorporating BV, PS, and MTT yielded an area under the curve of 0.92 with high sensitivity and specificity. Interobserver agreement for BF, BV, PS, and MTT was excellent, with intraclass correlation coefficients ≥0.889. These findings support DCE-CT as a reproducible and informative adjunct for preoperative meningioma vascular characterization and subtype stratification.