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AJNR - American Journal of Neuroradiology

Published ahead of print on September 20, 2007
doi: 10.3174/ajnr.A0647

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Assessment of Vasculature of Meningiomas and the Effects of Embolization with Intra-arterial MR Perfusion Imaging: A Feasibility Study

A.J. Martin^a, S. Cha^a, R.T. Higashida^a,b,c, S.P. Cullen^a, V. Halbach^a,b,c, C.F. Dowd^a,b,c, M.W. McDermott^b and D.A. Saloner^a

^a Departments of Radiology, University of California, San Francisco, Calif
^b Neurological Surgery, University of California, San Francisco, Calif
^c Neurology, University of California, San Francisco, Calif

View larger version (37K): [in this window] [in a new window]   Fig 1. Patient 1. This large right temporal meningioma was treated via embolization of the right middle meningeal artery. Perfusion MR images and x-ray angiograms are shown before (A–E) and after (F–H) embolization. The baseline MR perfusion image (A) reveals the tumor before administration of contrast. Difference images between this baseline and peak signal intensity attenuation after IV (E), IA CCA (B, F), and IA ECA (C, G) contrast injection are also shown. The ECA injection images reveal the portion of the tumor fed by this vessel before (C) and after (G) embolization. The x-ray angiograms were obtained with an ECA injection and revealed characteristic tumor blush (arrow) originating from the middle meningeal artery. The delivery of embolic agents through this vessel successfully obliterated this portion of the tumor vascular supply, which can be appreciated with both MR (G) and x-ray (H).

View larger version (44K): [in this window] [in a new window]   Fig 2. Patient 2. A large meningioma in the posterior fossa is evident on precontrast MR perfusion (A). Difference images between this baseline and peak signal intensity attenuation after IV (D) and IA right vertebral (B) contrast injection are shown. Selective x-ray angiograms obtained during a right vertebral injection reveal the pattern of the tumor (C). Embolization was administered more distally to this injection site (right posterior meningeal), and obliteration of the posterior component of the right vertebral distribution territory can be appreciated on the MR (E) and x-ray (F) images after embolization.

View larger version (37K): [in this window] [in a new window]   Fig 3. Patient 3. The figure summarizes the effects of embolization of a large right frontal meningioma. The upper row depicts the lesion before embolization and includes a precontrast perfusion source image (A), perfusion difference images between baseline and peak enhancement after right CCA (B) and ECA (C) injection, and a lateral view x-ray angiogram with a right ECA injection (D). Preembolization peak perfusion contrast after IV contrast administration is revealed (E). After embolization, the CCA (F) and ECA (G) perfusion studies and lateral view x-ray angiogram with a right ECA injection were repeated. Contrast injection into the right ECA demonstrates some residual attenuation (G) but is substantially reduced compared with the baseline state. The blush pattern in the proximity of the lesion that was evident on x-ray angiograms is no longer appreciable after treatment (H).