Differentiating microcystic meningioma from atypical meningioma using diffusion-weighted imaging

Purpose Microcystic meningioma (MCM) appears similar to atypical meningioma(AM) as per conventional diagnostic imaging. However, considering their different recurrence rate and prognosis, accurate differential diagnosis is essential for determine the appropriate treatment strategy. The aim of the study was to differentiate MCM from AM by diffusion-weighted imaging (DWI), in order to provide the basis for accurate preoperative diagnosis. Methods The preoperative clinical data, conventional MRI and DWI data of 15 MCM and 30 AM cases were retrospectively analyzed. The average apparent diffusion coefficient (ADC(mean)), minimum ADC (ADC(min)) and normalized ADC (nADC) between MCM and AM were compared using two sample t-tests. The value of ADC(mean), ADC(min) and nADC in the differential diagnosis of MCM and AM were calculated by the receiver operating curve (ROC) analysis. Results The ADC(mean) (1.06 +/- 0.10 vs 0.80 +/- 0.11 x 10(-3) mm(2)/s; P < 0.001), ADC(min) (0.99 +/- 0.10 vs 0.74 +/- 0.12 x 10(-3) mm(2)/s; P < 0.001) and nADC (1.45 +/- 0.17 vs 1.07 +/- 0.17; P < .0001) were significantly higher in MCM compared to AM. ADC(mean) of 0.91 x 10(-3) mm(2)/s showed an optimum area under the ROC curve of 0.967 +/- 0.022, and distinguished between MCM and AM with 86.67% sensitivity, 100% specificity and 88.89% accuracy. In addition, its positive and negative predictive values were 96.29% and 77.78% respectively. Conclusions DWI can differentially diagnose MCM and AM, and ADC(mean) is a potential quantitative tool that can improve preoperative diagnosis of both tumors.