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• Clinical Article •
Prediction of pathological grading and Ki-67 expression in intracranial extraventricular ependymomas based on VASARI quantitative features
ZHANG Ning  ZHAO Xuelian  HAN Xinling  YANG Dan  HU Wanjun  ZHANG Xue  LIU Hong  ZHANG Jing  LIU Guangyao 

DOI:10.12015/issn.1674-8034.2025.11.015.


[Abstract] Objective To analyze preoperative visually accessible rembrandt images (VASARI) features in patients with intracranial extraventricular ependymoma (IEE) and evaluate their predictive value for world health organization (WHO) grading and Ki-67 proliferation index.Materials and Methods Clinical and preoperative cranial MRI data of 30 pathologically confirmed IEE patients (18 WHO grade 2, 12 grade 3) who underwent surgical resection at Second Hospital of Lanzhou University (January 2012 to September 2024) were retrospectively analyzed. Two experienced neuroradiologists independently evaluated MRI characteristics according to VASARI criteria. SPSS 27.0 was used to analyze correlations between VASARI features and WHO grade/Ki-67 index. Diagnostic efficacy was assessed using receiver operating characteristic (ROC) curves.Results The VASARI total score was significantly higher in WHO grade 3 group (92.00 ± 18.75) versus grade 2 (76.22 ± 18.89, P < 0.05). ROC analysis showed AUC of 0.736 (95% CI: 0.541 to 0.931) for differentiating grade 3 from grade 2 tumors. At optimal cut-off ≥ 59.5, sensitivity was 94.1% and specificity 30.8%. Significant intergroup differences (P < 0.05) existed in cystic change rate (F8), enhancement rim thickness (F11), and peritumoral edema percentage (F14), with grade 3 tumors exhibiting higher cystic rates, thicker enhancement rims, and more extensive edema. VASARI total score positively correlated with WHO grade (r = 0.391, P = 0.032) and Ki-67 index (r = 0.370, P = 0.044). For predicting high Ki-67 expression, AUC was 0.633 (95% CI: 0.421 to 0.845) with 69.2% sensitivity and 82.4% specificity at cut-off ≥ 76.5.Conclusions The VASARI MRI features (F8, F11, F14, and total score) have certain value in non-invasively distinguishing WHO grade 2 from grade 3 IEE preoperatively and in predicting the Ki-67 proliferation index. They can serve as an auxiliary assessment tool to provide reference for clinical diagnosis and treatment.
[Keywords] intracranial extraventricular ependymoma；visually accessible Rembrandt images；magnetic resonance imaging；Ki-67；World Health Organization grading

ZHANG Ning1   ZHAO Xuelian1   HAN Xinling1   YANG Dan1   HU Wanjun1, 2, 3   ZHANG Xue1, 2, 3   LIU Hong1, 2, 3   ZHANG Jing1, 2, 3   LIU Guangyao1, 2, 3*  

1 Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou 730030, China

2 Gansu Provincial Clinical Research Center for Functional and Molecular Imaging, Lanzhou 730030, China

3 Gansu Industrial Technology Center for Medical MRI Equipment Applications, Lanzhou 730030, China

Corresponding author: LIU G Y, E-mail: lgy362263779@163.com

Conflicts of interest   None.

Received  2025-07-13
Accepted  2025-10-09
DOI: 10.12015/issn.1674-8034.2025.11.015
DOI:10.12015/issn.1674-8034.2025.11.015.

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