Standardizing Tumor Consistency of Intracranial Meningiomas
Standardizing Tumor Consistency of Intracranial Meningiomas
Fifty intracranial meningiomas in 50 patients were graded by 2 independent reviewers (100 scores total). The mean patient age was 52 years. There were 11 men and 39 women. The mean maximal tumor diameter (± SD) was 4.3 ± 1.5 cm. Tumors could be broadly categorized as follows: skull base (52%), convexity/parafalcine (44%), and intraventricular (4%). The specific distributions of tumor location are shown in Table 3. A prior resection had been attempted in 2 patients (4%). In 2 patients (1 who had a prior resection), radiation therapy had previously been performed. The distribution of scores for overall, minimum, and maximum grading is depicted in Fig. 1.
(Enlarge Image)
Figure 1.
Graph demonstrating the distribution of consistency scores (by percentage) for 50 graded meningiomas. The three lines represent the overall (blue), minimum (red), and maximum (green) consistency scores. Each score represents the average score from both graders.
The overall tumor consistency grade was perfectly correlated in 45 of the 50 cases (a 90% agreement). The kappa score for overall consistency grading was 0.87 (SE 0.06, 95% CI 0.76–0.99) (Table 4). The designation of "homogeneity versus heterogeneity" of tumor consistency was correlated in 42 of 50 patients (an 84% agreement). The kappa score for homogeneity versus heterogeneity was 0.64 (SE 0.12, 95% CI 0.41–0.86). Rater agreement was observed in the minimum tumor consistency score in 74% of tumors, with a kappa score of 0.69 (SE 0.08, 95% CI 0.52–0.85). Rater agreement was observed in the maximum tumor consistency score in 78% of tumors, with a kappa score of 0.75 (SE 0.07, 95% CI 0.61–0.90). The tumor vascularity grade (avascular, average, or vascular) was in agreement in 76% of patients, with a kappa score of 0.56 (SE 0.11, 95% CI 0.34–0.78).
There was no statistically significant correlation between patient age; tumor diameter; overall, minimum, and maximum consistency; or tumor heterogeneity. A higher graded tumor vascularity, however, was associated with a larger tumor diameter (> 5 cm) (p = 0.045, Fisher's exact test) and with a skull base location (p = 0.020, Fisher's exact test).
Results
Patient Demographics and Tumor Location
Fifty intracranial meningiomas in 50 patients were graded by 2 independent reviewers (100 scores total). The mean patient age was 52 years. There were 11 men and 39 women. The mean maximal tumor diameter (± SD) was 4.3 ± 1.5 cm. Tumors could be broadly categorized as follows: skull base (52%), convexity/parafalcine (44%), and intraventricular (4%). The specific distributions of tumor location are shown in Table 3. A prior resection had been attempted in 2 patients (4%). In 2 patients (1 who had a prior resection), radiation therapy had previously been performed. The distribution of scores for overall, minimum, and maximum grading is depicted in Fig. 1.
(Enlarge Image)
Figure 1.
Graph demonstrating the distribution of consistency scores (by percentage) for 50 graded meningiomas. The three lines represent the overall (blue), minimum (red), and maximum (green) consistency scores. Each score represents the average score from both graders.
Interuser Reliability of Grading System for Consistency
The overall tumor consistency grade was perfectly correlated in 45 of the 50 cases (a 90% agreement). The kappa score for overall consistency grading was 0.87 (SE 0.06, 95% CI 0.76–0.99) (Table 4). The designation of "homogeneity versus heterogeneity" of tumor consistency was correlated in 42 of 50 patients (an 84% agreement). The kappa score for homogeneity versus heterogeneity was 0.64 (SE 0.12, 95% CI 0.41–0.86). Rater agreement was observed in the minimum tumor consistency score in 74% of tumors, with a kappa score of 0.69 (SE 0.08, 95% CI 0.52–0.85). Rater agreement was observed in the maximum tumor consistency score in 78% of tumors, with a kappa score of 0.75 (SE 0.07, 95% CI 0.61–0.90). The tumor vascularity grade (avascular, average, or vascular) was in agreement in 76% of patients, with a kappa score of 0.56 (SE 0.11, 95% CI 0.34–0.78).
There was no statistically significant correlation between patient age; tumor diameter; overall, minimum, and maximum consistency; or tumor heterogeneity. A higher graded tumor vascularity, however, was associated with a larger tumor diameter (> 5 cm) (p = 0.045, Fisher's exact test) and with a skull base location (p = 0.020, Fisher's exact test).
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