Meningioma consistency, firmness or softness as it relates to resectability, affects the difficulty of surgery and, to some degree, the extent of resection. Preoperative knowledge of tumor consistency would affect preoperative planning and instrumentation. Furthermore, preoperative identification of vascularity of meningiomas can potentially reduce intraoperative blood loss and facilitate surgical resection.

The study was conducted during the period between January 2018 and October 2019 on a total of 40 patients ranging in age from 40 – 70 years, presenting by imaging findings suggestive of underlying meningioma referred from Neurosurgery department and clinic for further pre-operative MRI consistency and vascularity assessment.

Meningiomas were categorized into 3 categories according to intraoperative consistency; a) soft consistency including 19 cases (47.5%), b) intermediate consistency including 14 cases (35%) & c) firm consistency including 7 cases (17.5 %).
Compared to visual assessment of T2 signal intensity and quantitative diffusion based ADC values, tumor to cerebellar peduncle T2 intensity (TCTI) ratios showed the most significant MRI parameter in correlation with operative consistency of meningiomas, with soft lesions showing TCTI ranging from 1.75 to 2.87, intermediate consistency lesions ranging from 1.3 to 1.6, and firm lesions ranging from 0.9 to 1.2. ROC analysis showed 100% sensitivity, specificity, PPV and NPPV for TCTI ratio >1.6 in prediction of soft consistency, TCTI ratio ≤1.2 for firm consistency with intermediate consistency lesions having TCTI between >1.2 and ≤1.6.