Comparison of magnetic resonance imaging and histopathological findings of adult patients with primary brain tumors at Moi Teaching and Referral Hospital

Abstract

Background: Brain tumors are common and fatal, therefore requiring medical providers to have a basic understanding of their diagnosis and management. The management of patients with brain tumors depends on the imaging finding. Magnetic Resonance Imaging (MRI) is one of the imaging modalities while histopathology diagnosis is the gold standard in the diagnosis of brain tumors. Histopathology services are limited to referral hospitals, private laboratories and institutions. Objective: To describe and compare the radiological findings and histopathological diagnosis of primary brain tumors in adults at Moi Teaching and Referral Hospital (MTRH). Methods: This was a cross-sectional study design conducted from April 2019 to March 2020 at the MTRH Eldoret-Kenya. A total of 79 patients were enrolled into the study. Data was collected using interviewer administered questionnaire where the MRI findings of the respondents were analyzed and recorded. Histopathological diagnosis was followed up and recorded. Continuous variables, means and categorical variables were summarized in frequency, percentages and bar graphs. The comparison between the MRI and histopathology diagnosis of primary brain tumors in adult patients at MTRH was done using sensitivity and specificity. This was calculated using two-by-two (2X2) tables. Results: The age of the participants ranged from 18 to 85 years with a mean age of 46 years. The commonest clinical presentations were headache 71(80.68%), seizures 26(29.55%), vomiting 24(27.2%) and blurred vision 16(18.18%). The MRI diagnosis of brain tumors was meningioma 29(36.36%), glioblastoma, 24(30.68%) pituitary adenomas 12(13.64%) and diffuse astrocytoma 7(9.09%). There was a significant statistical association between tumor margins and type of tumor (p-value=0.044, Fisher Exact test). The presence of perilesional edema was significantly associated with the histopathological diagnosis (p-value=0.049, Fisher Exact test). The sensitivity of MRI in the diagnosis of meningioma, glioblastoma, pituitary adenoma and diffuse astrocytoma were 96.7%, 88.5%, 90.9% and 66.7 % respectively. The specificity ranged from 92.5-98.6 %. The overall diagnostic agreement between MRI and histopathology in the diagnosis of adult primary brain tumors in this study was 86.1%. Conclusion: The most common brain tumors in our study were meningiomas, glioblastoma, pituitary adenoma and diffuse astrocytoma in both radiological and histopathological diagnosis. The sensitivity and specificity of MRI in diagnosis of brain tumors ranged from 66.7%-96.8% and 92.5%-98.6% respectively. Recommendation: Use of MRI in the diagnosis of primary brain tumors in adults and guiding management is recommended.