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    Histogram analysis parameters apparent diffusion coefficient for distinguishing high and low-grade meningiomas: A multicenter study
    (Elsevier Science Inc, 2018) Surov, Alexey; Ginat, Daniel Thomas; Lim, Tchoyoson; Cabada, Teresa; Başkan, Özdil; Schob, Stefan; Meyer, Hans Jonas; Gihr, Georg Alexander; Horvath-Rizea, Diana; Hamerla, Gordian; Hoffmann, Karl Titus; Wienke, Andreas
    Low grade meningiomas have better prognosis than high grade meningiomas. The aim of this study was to measure apparent diffusion coefficient (ADC) histogram analysis parameters in different meningiomas in a large multicenter sample and to analyze the possibility of several parameters for predicting tumor grade and proliferation potential. Overall, 148 meningiomas from 7 institutions were evaluated in this retrospective study. Grade 1 lesions were diagnosed in 101 (68.2%) cases, grade 2 in 41 (27.7%) patients, and grade 3 in 6 (4.1%) patients. All tumors were investigated by MRI (1.5T scanner) by using diffusion weighted imaging (b values of 0 and 1000 s/mm (2)). For every lesion, the following parameters were calculated: mean ADC, maximum ADC, minimum ADC, median ADC, mode ADC, ADC percentiles P10, P25, P75, P90, kurtosis, skewness, and entropy. The comparison of ADC values was performed by Mann Whitney-U test. Correlation between different ADC parameters and KI 67 was calculated by Spearman's rank correlation coefficient. Grade 2/3 meningiomas showed statistically significant lower ADC histogram analysis parameters in comparison to grade 1 tumors, especially ADC median. A threshold value of 0.82 for ADC median to predict tumor grade was estimated (sensitivity = 82.2%, specificity = 63.8%, accuracy = 76.4%, positive and negative predictive values were 83% and 62.5%, respectively). All ADC parameters except maximum ADC showed weak significant correlations with KI 67, especially ADC P25 (P =-.340, P = .0001).