The natural history of intracranial meningiomas
The natural history of intracranial meningiomas
复制标题
DOI：
10.3171/2010.12.jns101623
复制
发表时间：
2011-05-01
影响因子：
4.1
通讯作者：
Lee, Joung H.
中科院分区：
文献类型：
--
作者：
Oya, Soichi;Kim, Seon-Hwan;Lee, Joung H.
Object.尽管偶然或小脑膜瘤的检出率增加，但病变的自然史在很大程度上是未知的。在2003年至2008年期间，对244例患者的273个脑膜瘤进行了一年或更长时间的随访，这些患者由一名外科医生保守治疗。根据年龄、性别、肿瘤位置、症状、初始肿瘤直径、钙化、MR成像强度和水肿对数据进行分层。线性肿瘤生长定义为肿瘤任何方向的最大直径增加2 mm或更大。还对273例脑膜瘤中的154例进行了体积分析（ImageJ版本1.43），在整个随访期间，完整的放射学数据以DICOM文件的形式提供。体积增加大于8.2%被认为是有意义的，因为基于随机选择的20个脑膜瘤的初步体积测定显示平均SD为4.1%。在120个肿瘤（44.0%）中观察到线性生长，平均随访3.8年。与肿瘤生长相关的因素为年龄小于等于60岁（p = 0.0004）、无钙化（p = 0.027）、MR成像T2信号高信号（p = 0.021）和水肿（p = 0.018）。Kaplan-Meier分析和考克斯比例风险回归分析显示，年龄60岁或以下的患者（风险比[HR] 1.54，95%CI 1.05-2.30，p = 0.026），初始肿瘤直径大于25 mm（HR 2.23，95% CI 1.44-3.38，p = 0.0004）和无钙化（HR 4.57，95% CI 2.69-8.20，p < 0.0001）是与进展时间短相关的因素。在74.0%的病例中观察到体积增长。与较高年生长率相关的因素为男性（p = 0.0002）、初始肿瘤直径大于25 mm（p < 0.0001）、MR成像T2信号高信号（p = 0.0001）、存在症状（p = 0.037）和水肿（p < 0.0001）。尽管作者可以根据测量方法获得不同的结果，但数据表明，年龄小于60岁的患者和T2加权MR成像上表现为高信号、无钙化、直径大于25 mm和水肿的脑膜瘤患者需要更密切地观察。容积法检测肿瘤生长比测量线性直径更敏感。(DOI：10.3171/2010.12.JNS101623）
Object. Despite the increased detection of incidental or small meningiomas, the lesion's natural history is largely unknown.Methods. One year or longer of follow-up was conducted in 244 patients with 273 meningiomas managed conservatively by a single surgeon between 2003 and 2008. Data were stratified according to age, sex, tumor location, symptoms, initial tumor diameter, calcification, MR imaging intensity, and edema. Linear tumor growth was defined as a 2-mm or larger increase in the maximum diameter in any direction of the tumor. Volumetric analysis (ImageJ version 1.43) was also conducted in 154 of 273 meningiomas for which complete radiological data were available in the form of DICOM files throughout the follow-up period. A volume increase greater than 8.2% was regarded as significant because the preliminary volumetry based on 20 randomly selected meningiomas showed that the average SD was 4.1%.Results. Linear growth was observed in 120 tumors (44.0%) with a mean follow-up of 3.8 years. Factors related to tumor growth were age of 60 or younger (p = 0.0004), absence of calcification (p = 0.027), MR imaging T2 signal hyperintensity (p = 0.021), and edema (p = 0.018). Kaplan-Meier analysis and Cox proportional hazards regression analysis revealed that age 60 or younger (hazard ratio [HR] 1.54,95% CI 1.05-2.30, p = 0.026), initial tumor diameter greater than 25 mm (HR 2.23, 95% CI 1.44-3.38, p = 0.0004), and the absence of calcification (HR 4.57, 95% Cl 2.69-8.20, p < 0.0001) were factors associated with a short time to progression. Volumetric growth was seen in 74.0% of the cases. Factors associated with a higher annual growth rate were male sex (p = 0.0002), initial tumor diameter greater than 25 mm (p < 0.0001),MR imaging T2 signal hyperintensity (p = 0.0001), presence of symptoms (p = 0.037), and edema (p < 0.0001).Conclusions. Although the authors could obtain variable results depending on the measurement method, the data demonstrate patients younger than 60 years of age and those with meningiomas characterized by hyperintensity on T2-weighted MR imaging, no calcification, diameter greater than 25 mm, and edema need to be observed more closely. Volumetry was more sensitive to detecting tumor growth than measuring the linear diameter. (DOI: 10.3171/2010.12.JNS101623)