Background: Meningiomas are occasionally fed by pial blood supply (PBS). It is postulated that peritumoral flow void (PTFV), peritumoral brain edema (PTBE), and absence of an arachnoid plane (AP) are useful parameters for evaluating PBS. Purpose: To determine whether conventional magnetic resonance imaging (MRI) using a multiparametric scoring system (MSS) is a useful way to predict PBS. Material and Methods: Forty-six patients were included and divided: PBS and non-PBS groups. Differences between the groups in six parameters of MR imaging were analyzed: tumor size, tumor location, PTBE grade, AP grade, PTFV, and MIB1 labeling index (MIB1-LI) grade. Cutoff values were determined using receiver operating characteristic (ROC) curve analysis for the differentiation of both groups based on statistically significant parameters. All cases were scored as 1 (PBS) or 0 (non-PBS) for each parameter according to set thresholds. Individual scores were totaled for each case, yielding a combined score for each case to obtain a cutoff value using ROC curve analysis for the MSS. Results: Peritumoral brain edema grade, AP grade, PTFV, and MIB-LI grade were statistically associated with PBS. Receiver operating characteristic curve analyses showed that PTBE grade 3 or 4, AP grade 3 or 4, and PTFV positivity had the highest accuracy of 69%, 64%, and 68%, respectively. Regarding the MSS, a cutoff value of 2 had the highest accuracy of 71%; PBS diagnosis was indicated by at least two of the three parameters, namely, PTBE grade, AP grade, and PTFV. Conclusion: The MSS is a useful way to predict PBS in intracranial meningiomas on MRI
