Incidental Meningioma: Modelling Growth Characteristics and Predicting Failure of Monitoring



Islim, A
(2018) Incidental Meningioma: Modelling Growth Characteristics and Predicting Failure of Monitoring. Master of Philosophy thesis, University of Liverpool.

[img] Text
200943971_July2018.pdf

Download (4MB)

Abstract

Meningiomas are the commonest primary intracranial tumours. With the increased access to neuro-radiological investigations, there has been a tremendous increase in the number of incidental findings. Incidental meningioma accounts for 10% of these findings and for 30% of newly-diagnosed meningiomas. International guidelines advise that these tumours are best managed using active clinical-radiological monitoring, however, duration of surveillance and intervals in between scans, remain unspecified. This uncertainty has economic implications and causes patient anxiety. Previous literature has focused primarily on radiological prognostication with little attention to the effect of clinical factors such as comorbidity and performance status on prognosis of incidental meningiomas. Moreover, the temporal relationship between these factors and progression remains poorly defined. The aims of this thesis therefore were to investigate the prognostic relationship between radiological factors and the timing of progression and to examine how this is augmented by clinical factors including patient age, comorbidity and performance status. Moreover, a predictive model of progression was built based on these factors and used to inform duration of follow-up and appropriate time-points for scans. Radiological factors included in the model were: increasing tumour volume, peritumoural signal change, MR FLAIR/T2 hyperintense meningiomas and proximity to critical neurovascular structures. Patients were stratified into low, medium and high-risk groups and rates of disease progression at 5-years were 3%, 28% and 75% respectively. Low-risk patients had non-oedematous, small iso/hypointense meningiomas, distant from neurovascular structures. Older patients with co-morbidities were 15-times more likely to die than to receive intervention at 5-years following diagnosis, regardless of risk-group. After 5-years of follow-up the probability of disease progression plateaued in all risk groups. Active monitoring strategies based on these results were formulated. These have the potential to reduce the cost burden of incidental meningiomas. Prospective studies are needed to validate the model.

Item Type: Thesis (Master of Philosophy)
Divisions: Fac of Health & Life Sciences > Faculty of Health and Life Sciences
Depositing User: Symplectic Admin
Date Deposited: 21 Nov 2018 14:56
Last Modified: 14 Sep 2019 07:10
URI: http://livrepository.liverpool.ac.uk/id/eprint/3025726
Repository Staff Access