Abstract
Introduction
To investigate the contribution of perfusion-weighted MRI to the differentiation of meningiomas with atypical conventional MRI findings from intraaxial tumors.
Methods
We retrospectively analyzed 54 meningiomas, 12 glioblastomas and 13 solitary metastases. We detected 6 meningiomas with atypical features on conventional MRI resembling intraaxial tumors. The regional cerebral blood flow (rCBV) ratios of all tumors were calculated via perfusion-weighted MRI. The signal intensity-time curves were plotted and three different curve patterns were observed. The type 1 curve resembled normal brain parenchyma or the postenhancement part was minimally below the baseline, the type 2 curve was similar to the type 1 curve but with the postenhancement part above the baseline, and the type 3 curve had the postenhancement part below the baseline accompanied by widening of the curve. Student’s t-test was used for statistical analysis.
Results
On CBV images meningiomas were hypervascular and the mean rCBV ratio was 10.58±2.00. For glioblastomas and metastatic lesions, the rCBV ratios were 5.02±1.40 and 4.68±1.54, respectively. There was a statistically significant difference in rCBV ratios between meningiomas and glioblastomas and metastases (P<0.001). Only one of the meningiomas displayed a type 2 curve while five showed a type 3 curve. Glioblastomas and metastases displayed either a type 1 or a type 2 curve. None of the meningiomas showed a type 1 curve and none of the glioblastomas or metastases showed a type 3 curve.
Conclusion
Differentiating meningiomas with atypical conventional MRI findings from malignant intraaxial tumors can be difficult. Calculation of rCBV ratios and construction of signal intensity-time curves may contribute to the differentiation of meningiomas from intraaxial tumors.
Similar content being viewed by others
References
Kleihues P, Cavenee WK (eds) (2000) Pathology and genetics of tumours of the nervous system. IARC Press, Lyon, France
Mahmood A, Caccamo DV, Tomecek FJ, Malik GM (1993) Atypical and malignant meningiomas: a clinicopathological review. Neurosurgery 33:955–963
Verheggen R, Finkenstaedt M, Bockermann V, Markakis E (1996) Atypical and malignant meningiomas: evaluation of different radiological criteria based on CT and MRI. Acta Neurochir (Wien) 65:66–69
Maier H, Ofner D, Hittmair A et al (1992) Classic, atypical, and anaplastic meningioma: three histopathological subtypes of clinical relevance. J Neurosurg 77:616–623
Harting I, Hartmann M, Bonsanto MM, Sommer C, Sartor K (2004) Characterization of necrotic meningioma using diffusion MRI, perfusion MRI, and MR spectroscopy: case report and review of the literature. Neuroradiology 46:189–193
Knopp EA, Cha S, Johnson G, Mazumdar A et al (1999) Glial neoplasms: dynamic contrast-enhanced T2*-weighted MR imaging. Radiology 211:791–798
Yang S, Law M, Zagzag D et al (2003) Dynamic contrast-enhanced perfusion MR imaging measurements of endothelial permeability: differentiation between atypical and typical meningiomas. AJNR Am J Neuroradiol 24:1554–1559
Hakyemez B, Erdogan C, Ercan I, Ergin N, Uysal S, Atahan S (2005) Distinguishing high-grade glioma from low-grade glioma with perfusion-weighted magnetic resonance imaging. Clin Radiol 60:493–502
Zee CS, Chen T, Hinton DR et al (1995) Magnetic resonance imaging of cystic meningiomas and its surgical implications. Neurosurgery 36:482–488
Perry A, Stafford SL, Scheithauer BW et al (1997) Meningioma grading: an analysis of histologic parameters. Am J Surg Pathol 21:1455–1465
Buetow MP, Buetow PC, Smirniotopoulos JG (1991) Typical, atypical and misleading features in meningioma. Radiographics 11:1087–1106
Guermazi A, Lafitte F, Miaux Y, Adem C, Bonneville JF, Chiras J (2005) The dural tail sign – beyond meningioma. Clin Radiol 60:171–188
Holodny AI, Nusbaum AO, Festa S, Pronin IN, Lee HJ, Kalnin AJ (1999) Correlation between the degree of contrast enhancement and the volume of peritumoral edema in meningiomas and malignant gliomas. Neuroradiology 41:820–825
Carvalho GA, Vorkapic P, Biewener G, Samii M (1997) Cystic meningiomas resembling glial tumors. Surg Neurol 47:284–289
Cha S, Knopp EA, Johnson G, Wetzel SG, Litt AW, Zagzag D (2002) Intracranial mass lesions: dynamic contrast-enhanced susceptibility-weighted echo-planar perfusion MR imaging. Radiology 223:11–29
Petrella JR, Provenzale JM (2000) MR perfusion imaging of the brain: techniques and applications. AJR Am J Roentgenol 175:207–219
Sugahara T, Korogi Y, Kochi M et al (1998) Correlation of MR imaging-determined cerebral blood volume maps with histologic and angiographic determination of vascularity of gliomas. AJR Am J Roentgenol 171:1479–1486
Speck O, Chang L, DeSilva NM, Ernst T (2000) Perfusion MRI of the human brain with dynamic susceptibility contrast: gradient-echo versus spin-echo techniques. J Magn Reson Imaging 12:381–387
Donahue KM, Krouwer HG, Rand SD et al (2000) Utility of simultaneously acquired gradient-echo and spin-echo cerebral blood volume and morphology maps in brain tumor patients. Magn Reson Med 43:845–853
Kremer S, Grand S, Remy C et al (2002) Cerebral blood volume mapping by MR imaging in the initial evaluation of brain tumors. Neuroradiology 29:105–113
Kremer S, Grand S, Remy C et al (2004) Contribution of dynamic contrast MR imaging to the differentiation between dural metastasis and meningioma. Neuroradiology 46:642–648
Principi M, Italiani M, Guiducci A et al (2003) Perfusion MRI in the evaluation of the relationship between tumour growth, necrosis and angiogenesis in glioblastomas and grade 1 meningiomas. Neuroradiology 45:205–211
Lim CC, Roberts TP, Sitoh YY, Hui F (2003) Rising signal intensity observed in extra-axial brain tumours – a potential pitfall in perfusion MR imaging. Singapore Med J 44:526–530
Author information
Authors and Affiliations
Corresponding author
Additional information
Conflict of interest statement
We declare that we have no conflict of interest.
Rights and permissions
About this article
Cite this article
Hakyemez, B., Yildirim, N., Erdoðan, C. et al. Meningiomas with conventional MRI findings resembling intraaxial tumors: can perfusion-weighted MRI be helpful in differentiation?. Neuroradiology 48, 695–702 (2006). https://doi.org/10.1007/s00234-006-0115-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00234-006-0115-y