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AJNR - American Journal of Neuroradiology

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MR Spectroscopy-Aided Differentiation: "Giant" Extra-Axial Tuberculoma Masquerading as Meningioma

P.C. Khanna^a, S. Godinho^a, D.P. Patkar^a, S.A. Pungavkar^a and M.A. Lawande^a

^a From the Department of Magnetic Resonance Imaging, Nanavati Hospital, Mumbai, India

View larger version (89K): [in a new window]   Fig 1. Axial T1WI (A; fast spin echo; TR/TE = 2015ms/9.7ms) and T2WI (B; fast spin echo; TR/TE = 4360ms/83ms) depicting a lobulated, dura-based lesion in the left frontal convexity that is predominantly hypointense on T1WI with a thick, iso-hypointense rim. On T2WI, it is of mixed intensity but predominantly hypointense with a hyperintense center. Displacement of the underlying parenchyma and a CSF cleft are identified (arrows). A large component of vasogenic edema is visualized.

View larger version (60K): [in a new window]   Fig 2. Axial DWI (A; TR/TE = 3000ms/11ms) depicts a dark-appearing lesion, with a hyperintense rim (arrows). Axial contrast-enhanced T1WI (B; Gd-DTPA enhanced fast spin echo; TR/TE = 2015ms/9.7ms) depicts prominent central enhancement, a thick peripheral nonenhancing component and rim-enhancement beyond this. There is thick enhancement of adjoining meninges ("dural-tail" sign, arrow) with mild enhancement of meninges in the anterior interhemispheric region and the right cerebral convexity (not shown).

View larger version (12K): [in a new window]   Fig 3. Single-voxel PRESS MR spectroscopy (A; TR/TE = 1500ms/35ms). Adequate water suppression has been achieved. Reading from right to left, peaks A and B (tall and broad) at 0.9 and 1.33 ppm, respectively, represent typical long-chain lipids (lipid/lactate). NAA and Cr are barely detectable. A small Cho peak, C, is seen to resonate at 3.2 ppm. Long TE MR spectroscopy (B; TR/TE = 1500ms/144ms) depicts persistence of predominant lipid peak at 1.33 ppm.