{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T17:50:28Z","timestamp":1786125028809,"version":"build-2736575974"},"reference-count":47,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["NEUROSURGERY","NEUROS"],"published-print":{"date-parts":[[2017,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    <jats:bold>BACKGROUND:<\/jats:bold>\n                    There is no objective and readily accessible method for the preoperative determination of atypical characteristics of a meningioma grade.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>OBJECTIVE:<\/jats:bold>\n                    To evaluate the feasibility of using fractal analysis as an adjunctive tool to conventional radiological techniques in visualizing histopathological features of meningiomas.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>METHODS:<\/jats:bold>\n                    A group of 27 patients diagnosed with atypical (WHO grade II) meningioma and a second group of 27 patients with benign (WHO grade I) meningioma were enrolled in the study. Preoperative brain magnetic resonance (MR) studies (T1-wieghted, post-gadolinium) were processed and analyzed to determine the average fractal dimension (FDa) and maximum fractal dimension (FDm) of the contrast-enhancing region of the tumor using box-count method. FDa and FDm as well as particular radiological features were included in the logistic regression model as possible predictors of malignancy.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>RESULTS:<\/jats:bold>\n                    The cohort consisted of 34 women and 20 men, mean age of 62 \u00b1 15 yr. Fractal analysis showed good interobserver reproducibility (Kappa &gt;0.70). Both FDa and FDm were significantly higher in the atypical compared to the benign meningioma group (\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    &lt; .0001). Multivariate logistic regression model reached statistical significance with\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = .0001 and AUC = 0.87. The FDm, which was greater than 1.31 (odds ratio [OR], 12.30;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = .039), and nonskull base localization (OR, .052;\n                    <jats:italic toggle=\"yes\">P<\/jats:italic>\n                    = .015) were confirmed to be statistically significant predictors of the atypical phenotype.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>CONCLUSION:<\/jats:bold>\n                    Fractal analysis of preoperative MR images appears to be a feasible adjunctive diagnostic tool in identifying meningiomas with potentially aggressive clinical behavior.\n                  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