Proposal of a Multiparametric Meningioma (MEN-CCVol) Score for Preoperative Discrimination of World Health Organization Grade 2/3 From Grade 1 Intracranial Meningiomas Based on Patient and MRI Characteristics

BACKGROUND AND OBJECTIVES: To propose a multiparametric score for discrimination of grade 2/3 from grade 1 intracranial meningiomas (IMs) based on preoperative patient and MRI data. METHODS: A retrospective cohort (n = 463) was used to test patient (age and sex) and MRI characteristics (volume, edema, necrosis, cysts, contrast patterns, edge irregularity, location) to detect a significant correlation with grade 2/3 IMs using binary logistic regression analysis with Hosmer-Lemeshow-test. All IMs were classified according to the 2021 classification. Depending on the variables' strength of correlation, points were assigned based on rounded β-coefficient from binary logistic regression and tallied together to form a total score. A cutoff score was defined by the highest Youden-index. The score was validated in a prospective (n = 211) and DNA methylation-based classification cohort (n = 18). Area under the curve (AUC), sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. RESULTS: Six variables were significantly correlated with grade 2/3 IMs (edema, location at the convexity, volume >40 cm 3 , male sex, necrosis and cysts). By applying 1 point for male sex, edema, and cysts and 2 points for location at the convexity, volume ≥40 cm 3 , and necrosis, a cutoff value of 3 was identified for discrimination (91 grade 2/3; 372 grade 1 IMs [AUC = 0.791, sensitivity 76.9%, specificity 64.8%, PPV 34.8% and NPV 92%]). The cutoff value 3 was confirmed in the validation cohort (45 grade 2/3 and 166 grade 1 IMs [AUC 0.773, sensitivity 86%, specificity 60.7%, PPV 35.9%, and NPV 95.2%]) and in the DNA methylation-based classification (6 grade 2/3 and 12 grade 1 IMs [AUC 0.750, sensitivity 75%, specificity 83.3%, PPV 90%, and NPV 62.5%]). CONCLUSION: The MEN-CCVol score ( M ale, E dema, N ecrosis, C onvexity, C yst, Vol ume) provides a readily applicable discrimination tool to identify grade 2/3 IMs. It may guide patients' counseling, timing of surgery, and surgical strategy. Further validation using genetic and epigenetic markers is required.