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Original research
Efficacy of endovascular intratumoral embolization for meningioma: assessment using dynamic susceptibility contrast-enhanced perfusion-weighted imaging
  1. Katsunori Asai1,2,
  2. Hajime Nakamura3,
  3. Yoshiyuki Watanabe4,
  4. Takeo Nishida3,
  5. Mio Sakai5,
  6. Atsuko Arisawa6,
  7. Masatoshi Takagaki3,
  8. Hideyuki Arita3,
  9. Tomohiko Ozaki3,
  10. Naoki Kagawa3,
  11. Yasunori Fujimoto3,
  12. Katsuyuki Nakanishi5,
  13. Manabu Kinoshita1,3,
  14. Haruhiko Kishima3
  1. 1Neurosurgery, Osaka International Cancer Institute, Osaka, Japan
  2. 2Neurosurgery, Osaka Neurological Institute, Toyonaka, Japan
  3. 3Neurosurgery, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
  4. 4Radiology, Shiga University of Medical Science, Otsu, Japan
  5. 5Diagnostic and Interventional Radiology, Osaka International Cancer Institute, Osaka, Japan
  6. 6Diagnostic and Interventional Radiology, Osaka University School of Medicine Graduate School of Medicine, Suita, Japan
  1. Correspondence to Dr Katsunori Asai, Neurosurgery, Osaka International Cancer Institute, Osaka 561-0836, Japan; asai-osk{at}


Background In preoperative embolization for intracranial meningioma, endovascular intratumoral embolization is considered to be more effective for the reduction of tumorous vascularity than proximal feeder occlusion. In this study, we aimed to reveal different efficacies for reducing tumor blood flow in meningiomas by comparing endovascular intratumoral embolization and proximal feeder occlusion using dynamic susceptibility contrast-enhanced perfusion-weighted imaging (DSC-PWI).

Methods 28 consecutive patients were included. DSC-PWI was performed before and after embolization for intracranial meningiomas. Normalized tumor blood volume (nTBV) of voxels of interest of whole tumors were measured from the DSC-PWI data before and after embolization. ΔnTBV% was compared between the cases that received intratumoral embolization and proximal feeder occlusion.

Results ΔnTBV% in the intratumoral embolization group (42.4±29.8%) was higher than that of the proximal feeder occlusion group (15.3±14.3%, p=0.0039). We used three types of embolic materials and ΔnTBV% did not differ between treatments with or without the use of each material: 42.8±42.4% vs 28.7±20.1% for microspheres (p=0.12), 36.1±20.6% vs 28.1±41.1% for n-butyl cyanoacrylate (p=0.33), and 32.3±37.3% vs 34.1±19.0% for bare platinum coils (p=0.77).

Conclusions The flow reduction effect of intratumoral embolization was superior to that of proximal feeder occlusion in preoperative embolization for intracranial meningioma in an assessment using DSC-PWI.

  • tumor
  • MR perfusion

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  • Contributors Concept and study design: KA, HN, YW, MK and HK. Data acquisition and analysis: KA, HN, YW, TK, MS, AA, MT, HA, TO, YF, KN and MK. Drafting of the manuscript and figures: KA, HN, MK and HK. Review and editing of the manuscript: all authors.

  • Funding This work was supported by the Japanese Society for Neuroendovascular Therapy grant number.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval This study was approved by the ethics committee of the local institutional review boards of Osaka University Hospital (approval number: 14184) and Osaka International Cancer Institute (approval number: 1503315260).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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