[Comprehensive treatment of patients with parasagittal meningiomas]

A radiomics model enables prediction venous sinus invasion in meningioma

OBJECTIVE

Preoperative prediction of meningioma venous sinus invasion would facilitate the selection of surgical approaches and predicting the prognosis. To predict venous sinus invasion in meningiomas, we used radiomic signatures to construct a model based on preoperative contrast-enhanced T1-weighted (T1C) and T2-weighted (T2) magnetic resonance imaging.

METHODS

In total, 599 patients with pathologically confirmed meningioma were retrospectively enrolled. For each patient enrolled in this study, 1595 radiomic signatures were extracted from T1C and T2 image sequences. Pearson correlation analysis and recursive feature elimination were used to select the most relevant signatures extracted from different image sequences, and logistic regression algorithms were used to build a radiomic model for risk prediction of meningioma sinus invasion. Furthermore, a nomogram was built by incorporating clinical characteristics and radiomic signatures, and a decision curve analysis was used to evaluate the clinical utility of the nomogram.

RESULTS

Twenty radiomic signatures that were significantly related to venous sinus invasion were screened from 3190 radiomic signatures. Venous sinus invasion was associated with tumor position, and the clinicoradiomic model that incorporated the above characteristics (20 radiomic signatures and tumor position) had the best discriminating ability. The areas under the curve for the training and validation cohorts were 0.857 (95% confidence interval [CI], 0.824-0.890) and 0.824 (95% CI, 0.752-0.8976), respectively.

INTERPRETATION

The clinicoradiomic model had good predictive performance for venous sinus invasion in meningioma, which can aid in devising surgical strategies and predicting prognosis.

Effectiveness of Super-selective Embolization for Parasagittal Meningiomas and Its Effect on the Level of Inflammatory Factors

Objective

To evaluate the effectiveness of super-selective embolization for parasagittal meningiomas and its effect on the level of inflammatory factors.

Methods

A total of 48 patients with parasagittal meningiomas diagnosed and treated in our hospital from September 2018 to March 2020 were randomly included and assigned to receive meningioma resection (control group) or meningioma resection plus super-selective embolization (study group), with 24 patients in each group. Outcome measures included clinical indices, tumor resection outcome, inflammatory factor levels, and follow-up results.

Results

Patients in the study group had shorter operative time and less intraoperative bleeding volume than those in the control group (P < 0.05). The study group had more patients with Simpson I resection (87.50%) than the control group (62.50%) (P < 0.05). There was no statistically significant difference in the levels of inflammatory factors between the two groups of patients before treatment (P > 0.05). After treatment, the levels of interleukin (IL)-6, tumor necrosis factor (TNF)-α, and hypersensitive C-reactive protein (hs-CRP) in patients in the study group were significantly lower than those of the control group. The results of the three-month follow-up showed that one patient in the study group was reoperated for tumor recurrence and there was no death record, while three patients in the control group were reoperated for tumor recurrence and one patient died. The difference in the recurrence and mortality between the two groups did not come up to the statistical standard (P > 0.05).

Conclusion

Super-selective embolization for parasagittal meningiomas contributes to reducing intraoperative bleeding, effectively improving tumor resection and surgical safety, and lowering inflammatory factor levels. Further trials are, however, required before clinical promotion.