Early stage T1-weighted perfusion magnetic resonance imaging: a factor that predicts local control response in patients with meningioma who underwent gamma-knife radiosurgery

ABSTRACT

Background

Gamma-knife radiosurgery (GKRS) is an alternative treatment option for selected intracranial meningiomas. The study’s aim is to demonstrate the advantages of T1-weighted perfusion magnetic resonance imaging (T1-PMRI) by measuring the volume transfer coefficient (K^trans) values in the prediction of local response for patients with meningioma who have undergone GKRS consecutively.

Methods

The data of patients diagnosed radiologically with WHO grade 1 intracranial meningiomas was collected prospectively. The patients who were treated consecutively with GKRS at our institution (September 2017–September 2018) were included. After GKRS, the patients were followed up at the defined periods with routine contrast-enhanced MRI and T1-PMRI by measuring the K^trans. The comparison between the pre-treatment and third-month post-treatment (PO3M) K^trans was done using the Wilcoxon signed-rank test.

Results

Thirty-one patients with 36 tumors have undergone GKRS. Twenty-two patients were female. The mean age was 55.3 years. The mean pre-GKRS volume was 7.67 ccs. The mean 50% radiation isodose was 12.2 Gy. The local tumor control rate was 100%. Fourteen tumors were regressed fully at the last MRI. PO3M K^trans decreased when compared with the pre-GKRS values (p < 0.0001). However, the numerical decrease in tumor volumes on contrast-enhanced MRI was not statistically significant (p = 0.117).

Conclusion

Changes between K^trans on PO3M and pre-GKRS T1-PMRI were more useful in determining the early response to GKRS in patients with meningioma than volumetric changes. Therefore, K^trans should be taken as a reference to predict the early response to GKRS in follow-up imaging scans.

KEYWORDS:

• Gamma knife stereotactic radiosurgery
• meningioma
• dynamic contrast-enhanced magnetic resonance imaging
• K^trans
• post-GKRS follow-up

Abbreviations

DCE-MRI: Dynamic contrast-enhanced magnetic resonance imaging; DSC-MRI: Dynamic susceptibility contrast magnetic resonance imaging; GKRS: Gamma knife radiosurgery,K^trans: the volume transfer coefficient; MRI: Magnetic resonance imaging; KPS: Karnoffsky Performance Score; PO3M: the third-month post-treating; SPSS: Statistical package software for the social sciences; T1-PMRI: T1-weighted perfusion magnetic resonance imaging; WHO: World health organization.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Research involving human participants and/or animals

This study was approved under decision number: (13/11) by the medical ethics committee of the Medical Faculty of BVU in Istanbul-Turkey.

Ethical approval

This prospective study was approved on 21 June 2017, with decision number: (13/11) by the medical ethics committee of Bezmialem Vakif University (BVU) in Istanbul-Turkey

Informed consent

Informed consent was obtained from the patients for participation and treatment.

Statement of authorship

AnA**: Conceptualization, Methodology, Software, Supervision, Formal analysis, Literature review, Visualization, Investigation, Writing – Original draft, Writing – Review, Statistical analysis; MHS**: Conceptualization, Supervision, Literature Review, Writing – Review, Data Collection, Writing – Original draft; MGP**: Literature Review, Writing – Review, Data Collection, Writing – Original draft, Validation; AyA: Conceptualization, Methodology, Software, Supervision, Literature review, Formal analysis; SY: Validation; GB: Validation.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes on contributors

Anas Abdallah

Anas Abdallah currently works as an associate professor in Neurosurgery and Spine surgery, at the Department of Neurosurgery, Istanbul Training and Research Hospital, Istanbul-Turkey. Anas does research in Neurosurgery, Neurovascular Surgery, Spine Surgery, and Neurooncology. Their most recent publication is ”Management of myxopapillary ependymoma: a retrospective study from three institutions”. Up-to-date, Anas has 47 published articles in journals indexed by the PUBMED index.

Mehmet Hakan Seyithanoğlu

Mehmet Hakan Seyithanoğlu currently works as an associate professor in Neurosurgery, vascular surgery, and gamma knife unit, at the Department of Neurosurgery, Bezmialem Vakıf University, Istanbul-Turkey. Hakan does research in Neurosurgery, Neurovascular Surgery, Spine Surgery, and Neurooncology. Their most recent publication is ”Effects of Methylprednisolone in the Treatment of Spinal Cord Injuries by Evaluation of microRNA-21: An Experimental Study”. Up-to-date, Hakan has 27 published articles in journals indexed by the PUBMED index.

Meliha Gündağ Papaker

Meliha Gündağ Papaker currently works as a neurosurgeon and lecturer, at the Department of Neurosurgery, Bezmialem Vakıf University, Istanbul-Turkey. Meliha does research in Pediatric Neurosurgery and Spine Surgery. Up-to-date, Meliha has 15 published articles in journals indexed by the PUBMED index.

Ayşe Aralaşmak

Ayşe Aralaşmak currently works as a professor in Neuroradiology, at the Department of Radiology, Memorial Bahcelievler Hospital, Istanbul-Turkey. Ayşe does research in Neuroradiology and Diagnostic Radiology. Their most recent publication is ”Comparing Perfusion Data of CE-MRI, SWI, and CTA with MR Perfusion in Stroke”. Up-to-date, Anas has 65 published articles in journals indexed by the PUBMED index

Selçuk Yapar

Selçuk Yapar currently works as a neurosurgeon, at the Department of Neurosurgery, Beylikdüzü State Hospital, Istanbul-Turkey. Selçuk does research in Neurosurgery, Spine Surgery, and Neurooncology.

Gökhan Baloğlu

Gökhan Baloğlu currently works as a neurosurgeon, at the Department of Neurosurgery, Osmaniye State Hospital, Osmaniye-Turkey. Gökhan does research in Neurosurgery, Spine Surgery, and Neurooncology.