Ces radiol. 2025, 79(3):196-207 | DOI: 10.55095/CesRadiol2025/021

Pre-operative grading of meningioma using multiparametric magnetic resonance imaging with inclusion of diffusion weighted imaging and susceptibility weighted imagingOriginal article

Alaa Nasser Hussain Zaher¹, Khalid Esmat Allam¹, Mohamed Elsayed Ali Nosseir², Eman A. F. Darwish¹, Mohamed Kamal Ahmed Teiba¹

¹ Department of Diagnostic and Interventional Radiology, and Molecular Imaging, Ain Shams University, Faculty of Medicine, Cairo, Egypt

² Department of Neurosurgery, Ain Shams University, Faculty of Medicine, Cairo, Egypt Correspondence address:

Aim: Meningiomas, one of the most prevalent primary central nervous system tumors among adults. They were previously studied qualitatively using several morphological characteristics to detect their biological behaviour. However, many of these studies were controversial due to variable sample sizes and subjectivity in their assessment.  Method:  study evaluated the benefits of a multi-parametric MRI method comparing morphological data and advanced quantitative diffusion and semi-quantitative SWI parameters in the pre-operative grading of meningiomas. We investigated 36 patients recruited from the neurosurgery out who had extra axial masses with features of meningioma in MRI.  Results: A total of 36 patients were recruited and underwent routine MRI of the brain, followed by DWI and SWI. Morphological features, like tumor size, unclear TBI, lobulated tumor margins, heterogenous contrast enhancement, were significantly higher in high grade meningiomas. Low grade meningiomas had significantly higher Mean ADC value and normalized form of ADC (n ADC) in the tumor (ratio between tumor and normal side in ADC). Cut off value of the mean ADC and n ADC in the tumor for the high grade were ≤ 0.7126 and ≤ 0.9469 respectively. ITSSs seen in SWI, showed significant difference between both groups where the most common grade seen in low grade meningiomas was grade 1 and the most common grades seen in high grade meningiomas were grades 2 and 3, seen equally. Sensitivity of the n ADC in the tumor was (85.71%) and specificity was (96.55%) with diagnostic accuracy (86.7%). While sensitivity of SWI to detect high grade tumors was (85.71%), specificity was (68.97%) and accuracy was (72.22%). Therefore, the combination between (SWI & DWI) as diagnostic tools, increased sensitivity to 87.5%, specificity to 100%, and diagnostic accuracy to 97.2%. Combination between DWI and SWI also narrows down cases where SWI helps excluding cases of very low grade and high grade and saves DWI for differentiation of cases in between.  Conclusion: High grade meningiomas in conventional images were strongly associated with large tumor size, unclear TBI, lobulated tumor margins, heterogenous contrast enhancement, midline shift and intratumoral cysts. While in advanced techniques like DWI, high grade meningiomas were strongly associated with lower mean ADC values in the tumor, n ADC in the tumor, and more ITTSSs (grade 2, 3) using SWI. Combination of the quantitative DWI and semi-quantitative assessment of SWI led to the increase of sensitivity, specificity and diagnostic accuracy and less time consumption for preoperative grading of meningiomas.

Keywords: Magnetic resonance imaging. Meningioma, Radiological grading, Histopathological grading, DWI, SWI.

Received: August 22, 2025; Revised: August 22, 2025; Accepted: August 31, 2025; Published: December 1, 2025  Show citation