Accurate Preoperative Distinction of Intracranial Hemangiopericytoma From Meningioma Using a Multihabitat and Multisequence-Based Radiomics Diagnostic Technique

Background: Intracranial hemangiopericytoma (IHPC) and meningioma are both meningeal neoplasms, but they have extremely different malignancy and outcomes. Because of their similar radiological characteristics, they are difficult to distinguish prior to surgery, leading to a high rate of misdiagnosis. Methods: We enrolled 292 patients (IHPC, 155; meningiomas, 137) with complete clinic-radiological and histopathological data, from a 10-year database established at Tiantan hospital. Radiomics analysis of tumor and peritumoral edema was performed on multisequence magnetic resonance images, and a fusion radiomics signature was generated using a machine-learning strategy. By combining clinic-radiological data with the fusion radiomics signature, we developed an integrated diagnostic approach that we named the IHPC and Meningioma Diagnostic Tool (HMDT). Results: The HMDT displayed remarkable diagnostic ability, with areas under the curve (AUCs) of 0.985 and 0.917 in the training and validation cohorts, respectively. The calibration curve showed excellent agreement between the diagnosis predicted by HMDT and the histological outcome, with p-values of 0.801 and 0.622 for the training and the validation cohorts, respectively. Cross-validation showed no statistical difference across three divisions of the cohort, with average AUCs of 0.980 and 0.941 for the training and validation cohorts, respectively. Stratification analysis showed consistent performance of the HMDT in distinguishing IHPC from highly misdiagnosed subgroups of grade I meningioma and angiomatous meningioma (AM) with AUCs of 0.913 and 0.914 in the validation cohorts for the two subgroups. Conclusions: By integrating clinic-radiological information with radiomics signature, the proposed HMDT could assist in preoperative diagnosis to distinguish IHPC from meningioma, providing the basis for strategic decisions regarding surgery.

[1]  Yikai Xu,et al.  Whole-tumor histogram analysis of apparent diffusion coefficient in differentiating intracranial solitary fibrous tumor/hemangiopericytoma from angiomatous meningioma. , 2019, European journal of radiology.

[2]  M. Jinzaki,et al.  Preoperative Prediction of Solitary Fibrous Tumor/Hemangiopericytoma and Angiomatous Meningioma Using Magnetic Resonance Imaging Texture Analysis. , 2018, World neurosurgery.

[3]  Sung Tae Kim,et al.  Diffusion radiomics as a diagnostic model for atypical manifestation of primary central nervous system lymphoma: development and multicenter external validation , 2018, Neuro-oncology.

[4]  S. Lui,et al.  Psychoradiologic Utility of MR Imaging for Diagnosis of Attention Deficit Hyperactivity Disorder: A Radiomics Analysis. , 2017, Radiology.

[5]  P. Lambin,et al.  Radiomics: the bridge between medical imaging and personalized medicine , 2017, Nature Reviews Clinical Oncology.

[6]  Zhenchao Tang,et al.  Radiomics Analysis for Evaluation of Pathological Complete Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer , 2017, Clinical Cancer Research.

[7]  M. Castillo,et al.  Uncommon Cranial Meningioma: Key Imaging Features on Conventional and Advanced Imaging , 2017, Clinical Neuroradiology.

[8]  Yanqi Huang,et al.  Development and Validation of a Radiomics Nomogram for Preoperative Prediction of Lymph Node Metastasis in Colorectal Cancer. , 2016, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[9]  G. Reifenberger,et al.  The 2016 World Health Organization Classification of Tumors of the Central Nervous System: a summary , 2016, Acta Neuropathologica.

[10]  Erich P Huang,et al.  MR Imaging Radiomics Signatures for Predicting the Risk of Breast Cancer Recurrence as Given by Research Versions of MammaPrint, Oncotype DX, and PAM50 Gene Assays. , 2016, Radiology.

[11]  N. Mama,et al.  MR imaging of intracranial hemangiopericytomas. , 2014, Journal of neuroradiology. Journal de neuroradiologie.

[12]  W. Peng,et al.  Comparison of ADC values of intracranial hemangiopericytomas and angiomatous and anaplastic meningiomas. , 2014, Journal of neuroradiology. Journal de neuroradiologie.

[13]  Zhiye Chen,et al.  Intracranial hemangiopericytoma: MR imaging findings and diagnostic usefulness of minimum ADC values , 2013, Journal of magnetic resonance imaging : JMRI.

[14]  J. Barnholtz-Sloan,et al.  CBTRUS statistical report: primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. , 2012, Neuro-oncology.

[15]  Junlin Zhou,et al.  Thirty-nine cases of intracranial hemangiopericytoma and anaplastic hemangiopericytoma: a retrospective review of MRI features and pathological findings. , 2012, European journal of radiology.

[16]  M. Berger,et al.  Intracranial hemangiopericytoma , 2012, Cancer.

[17]  Patrick Granton,et al.  Radiomics: extracting more information from medical images using advanced feature analysis. , 2012, European journal of cancer.

[18]  J. Dai,et al.  Intracranial Meningeal Hemangiopericytomas in Children and Adolescents: CT and MR Imaging Findings , 2012, American Journal of Neuroradiology.

[19]  N. Kitchen,et al.  Hemangiopericytoma: long-term outcome revisited. Clinical article. , 2011, Journal of neurosurgery.

[20]  N. Sibtain,et al.  Imaging features of central nervous system haemangiopericytomas , 2007, European Radiology.

[21]  I. McCutcheon,et al.  Intracranial meningeal hemangiopericytoma: The role of radiotherapy , 2004, Cancer.

[22]  D. Piepgras,et al.  Hemangiopericytoma of the confluence of sinuses and the transverse sinuses. Case report. , 2003, Journal of neurosurgery.

[23]  J. Smirniotopoulos,et al.  Intracranial hemangiopericytomas: MR and CT features. , 1996, AJNR. American journal of neuroradiology.

[24]  B. Scheithauer,et al.  Meningeal hemangiopericytoma: histopathological features, treatment, and long-term follow-up of 44 cases. , 1989, Neurosurgery.

[25]  R. L. Font,et al.  Hemangiopericytoma of the meninges of the optic nerve. A clinicopathologic report including electron microscopic observations. , 1985, Ophthalmology.

[26]  A. Stout,et al.  HEMANGIOPERICYTOMA: A VASCULAR TUMOR FEATURING ZIMMERMANN'S PERICYTES. , 1942, Annals of surgery.

[27]  J. Barnholtz-Sloan,et al.  American Brain Tumor Association Adolescent and Young Adult Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012. , 2016, Neuro-oncology.

[28]  Jill S. Barnholtz-Sloan,et al.  CBTRUS Statistical Report: Primary Brain and Central Nervous System Tumors Diagnosed in the United States in 2008-2012 , 2015, Neuro-oncology.

[29]  Micha Elsner,et al.  Feature Selection , 2014, Computer Vision, A Reference Guide.

[30]  D. Louis.  WHO classification of tumours of the central nervous system , 2007 .

[31]  A. Lagares,et al.  Intracranial Hemangiopericytoma: Study of 12 Cases , 2001, Acta Neurochirurgica.

[32]  A R Tate,et al.  Magnetic resonance spectroscopy of brain hemangiopericytomas: high myoinositol concentrations and discrimination from meningiomas. , 2001, Journal of neurosurgery.

[33]  J. Sneep.  With a summary , 1945 .