# Predicting intraoperative meningioma consistency using features from standard MRI sequences: a preoperative evaluation

## TL;DR

This study uses MRI features to predict meningioma tumor consistency before surgery, helping surgeons plan more effectively.

## Contribution

The study introduces a preoperative MRI-based method to classify meningioma consistency using qualitative and quantitative features.

## Key findings

- Soft tumors show homogeneous contrast enhancement, high T2 signal, and absence of peritumoral edema.
- Firmer tumors exhibit heterogeneous contrast enhancement, low T2 signal, and presence of peritumoral edema.
- Tumor signal on T2 and ADC maps moderately correlates with tumor consistency.

## Abstract

Symptomatic meningiomas may require surgical resection to save or improve neurological function. The extent of tumor resection depends on multiple factors, including the tumor's consistency, its location, and the patient's overall condition. This prospective study aims to explore new criteria in combination with previously proposed tumor features on MRI to establish a rapid approach to tumor consistency characterization pre-operatively.

Forty-eight patients with meningiomas were prospectively included and underwent a dedicated MRI protocol prior to surgery. Qualitative and quantitative MRI characteristics of the tumor were correlated to a previously proposed surgical tumor consistency grading.

Soft tumors were associated with homogeneous contrast enhancement, high T2 signal, absence of peritumoral edema (PTE), the presence of tumor cysts, and a uniformly dark appearance on fractional anisotropy (FA) maps. In contrast, firmer tumors were characterized by heterogeneous contrast enhancement, low T2 signal, the presence of PTE, absence of tumor cysts and a heterogeneous appearance on FA maps, requiring supranormal ultrasonic aspirator settings. Tumor signal quantification on T2 and Apparent Diffusion Coefficient maps (ADC) correlated moderately to tumor consistency. T1 sequences did not contribute in determining tumor consistency.

An array of simple qualitative meningioma characteristics on MRI can assist in swift discrimination of soft and hard tumors preoperatively. These have been displayed in a figure that can easily be implemented clinically for optimal surgical planning.

The online version contains supplementary material available at 10.1007/s00701-025-06582-9.