Meningioma Hyperostotic Subtype Defines a TRAF7-Associated Phenotype

Abstract Background Meningioma-induced hyperostosis (MIH) is a frequent radiographic finding, yet its underlying mechanisms remain poorly understoodWhile hyperostosis has traditionally been treated as a binary phenomenon, the aim of this study was to determine whether MIH represents a heterogenous process with distinct radiological subtypes associated with genetic associations. Methods We retrospectively reviewed the records and imaging of patients with meningiomas resected between 2021-2024 at a single institution. Somatic mutations identified through next-generation sequencing were analyzed. CT images were analyzed for bone involvement and hyperostosis subtype. Type I hyperostosis was defined by destruction of cortical architecture while Type II hyperostosis was defined by the preservation of cortical structure. Associations with TRAF7 mutations were assessed using univariate testing, multivariable logistic regression, and supervised machine-learning models. Quantitative bone density analysis was performed using region-of-interest grayscale histogram analysis. Results Among 384 tumors, 54 (14.1%) exhibited hyperostosis—23 Type I and 31 Type II. TRAF7 mutations were significantly enriched in Type I hyperostosis compared with Type II and non-hyperostotic tumors (78.3% vs 25.8% vs 17.0%, p