Brain Compression without Global Neuronal Loss in Meningiomas: Whole-Brain Proton MR Spectroscopy Report of 2 Cases
Benjamin A. Cohena,
Edmond A. Knoppa,b,
Henry Rusineka,
Songtao Liua and
Oded Gonena
a Department of Radiology, New York University School of Medicine, New York, NY
b Department of Neurosurgery, New York University School of Medicine, New York, NY
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FIG 1. Top, Sagittal, axial and coronal T1-weighted images pre- and postcontrast for patient 1. Note the large (6 x 5 x 5 cm3) extra-axial lesion in the right parietal region, surrounding small cysts (largest  1.5-cm diameter, arrow) and marked mass effect on the right lateral ventricle, midline shift, and sulcal effacement.
Bottom, Same for Patient 2. Note the large (9 x 6 x 4 cm3) lesion with its broad dural tail superiorly in the midline extending bilaterally through the falx and into the calvaria, homogenous enhancement, and mass effect reflected in displacement of both lateral ventricles and corpus callosum with moderate left-to-right midline shift.
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FIG 2. Top, Sagittal T1 for patients 1 and 2. The red sulcal and ventricular outline is tissue/CSF segmentation. The extra-axial mass (outlined in green) is excluded from initial brain volume but then included to approximate preneoplastic VB.
Bottom, Axial fluid-attenuated inversion recovery and T2-weighted image for patients 1 and 2, respectively. In patient 2, note the considerable T2 hyperintensity, consistent with vasogenic edema, in the underlying parenchyma, particularly in the left centrum semiovale and parietal lobe.
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FIG 3. Plot of first, second (median), and third quartiles (box) and ±95% (whiskers) range of the controls’ WBNAA distribution versus "measured" and "adjusted" levels of the 2 patients. Note that "measured" WBNAA (excluding the meningioma from brain volume) is significantly elevated, which suggests parenchymal compression. Correction of VB to preneoplastic size rendered adjusted WBNAA within the normal range, which indicates neuronal preservation.
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