Does tumor size, peritumoral edema, location and necrosis can be used to predict grading or meningioma?

Background: Meningioma based on WHO classification divided into grade I (typical or benign, 88-94%), grade II (atypical, 5-7%) and grade III (anaplastic or malignant, 1-2%).1 Treatment of meningioma is tailored to their histological grade.2
Objective: The purpose of this study was to examine whether imaging features included tumor size, peritumoral edema, location and necrosis on conventional MRI could be used to predict grading of meningioma.
Method: We performed a retrospective review of 20 patients which histopathologically confirmed after surgical resection, who where imaged with MRI at our institution from 2016 until 2019. Image features of each sample include tumor size, peritumoral edema, location and necrosis was analysed and correlate with WHO histopathological grading.
Result: In our study from 20 patients, age range from 21 to 67 years old, 16 female, 4 male, 16 classified as WHO grade I, 3 grade II, and 1 grade III, with histopathology mostly transitional type. Tumor volume ranges from 17-252.4cm3 in grade I, 28.5-143cm3 in grade II & 190cm3 in grade III, necrosis present in 44% of grade I, 33% of grade II and 100% of grade III. Based on location from 16 cases of grade I, mostly in convexity, 2 out of 3 grades II in skull base and 1 case of grade III in convexity. In WHO grade I, 44% have severe edema and conversely case of grade III have mild edema.
Conclusion: Imaging features of tumor size, peritumoral edema, location and necrosis broadly varied in each grade of meningioma, Advanced MRI such as DTI should be study to found more promising predictor.