Preoperative prediction of meningioma consistency using tumor-to-cerebellar peduncle intensity ratios on T2WI, DWI, and ADC maps.

Meningioma consistency is a critical factor in surgical planning, as firmer tumors are more difficult to resect and may increase operative time and risk. This study aimed to evaluate whether tumor-to-cerebellar peduncle T2-weighted imaging intensity (TCTI) ratios derived from T2-weighted imaging (T2WI), diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps can serve as reliable, noninvasive predictors of tumor consistency. This retrospective study included 102 patients with supratentorial WHO grade I meningiomas who underwent surgical resection between January 2021 and October 2024. Tumor consistency was classified intraoperatively as soft or hard. Preoperative 3T MRI data were analyzed to calculate TCTI ratios using signal intensities from T2WI, DWI, and ADC maps. Among the 102 tumors, 54 were classified as soft and 48 as hard. Soft tumors showed significantly higher signal intensities on T2WI and DWI, and higher ADC values. TCTI ratios from T2WI, DWI, and ADC were significantly correlated with consistency (P = .01, <.001, and <.001, respectively). Logistic regression analysis confirmed that TCTI ratios derived from T2WI (95% CI: 1.429-22.095; P = .013) and ADC values (95% CI: 0.008-0.477; P = .007) were independent predictors of tumor consistency. Receiver operating characteristic analysis identified optimal TCTI cutoffs of 1.42 for T2WI (sensitivity: 62.5%, specificity: 57.4%) and 1.14 for ADC (sensitivity: 60.5%, specificity: 81.4%). TCTI ratios derived from T2WI and ADC maps are effective, noninvasive markers for predicting meningioma consistency. Their use in preoperative imaging may enhance surgical planning and improve clinical outcomes.