Differential diagnosis of intracranial solitary fibrous tumor and high-grade meningioma based on CT and MRI features

Background ISFT and HGM exhibit similar imaging characteristics, but their distinct behaviors and treatments necessitate accurate preoperative imaging for optimal management. Purpose To evaluate conventional CT and MRI in differentiating ISFT from HGM. Methods Retrospective analysis of clinical data, CT, and MRI images from 31 ISFT and 50 HGM patients confirmed by pathology. Various imaging features were examined, including tumor size, shape (lobulated or round), base width (narrow or broad), presence of cystic necrosis, calcification, signal intensity on T1- and T2-weighted MRI, intravascular flowing-void signs, peritumoral edema, CT attenuation values on non-enhanced and enhanced scans, and adjacent bone destruction. Chi-square tests, t-tests, ROC curves, and multivariate logistic regression were used to establish predictive models. A nomogram illustrated the final model. Results ISFT onset age was ≤48.5 years, with a maximum tumor diameter of ≥4.5 cm. Features included lobulated appearance, narrow base, cystic necrosis, absence of calcification, low T1-weighted MRI signal, intravascular flowing-void signs, peritumoral edema, CT value ≤51.7 Hu on non-enhanced and ≥107.6 Hu on enhanced scans, and adjacent bone destruction. Combining tumor diameter, vascular flowing void, enhanced CT value, and absence of calcification yielded 92.0% sensitivity and 90.3% specificity for ISFT diagnosis. Conclusion Age and imaging characteristics effectively differentiate ISFT from HGM, particularly with a tumor diameter ≥4.5 cm, vascular flowing-void signals, absence of calcification, and enhanced CT value ≥107.6 Hu. A nomogram shows good predictive efficacy.