Skip to main content

Advertisement

Log in

Meningiomas with conventional MRI findings resembling intraaxial tumors: can perfusion-weighted MRI be helpful in differentiation?

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Kleihues P, Cavenee WK (eds) (2000) Pathology and genetics of tumours of the nervous system. IARC Press, Lyon, France

  2. Mahmood A, Caccamo DV, Tomecek FJ, Malik GM (1993) Atypical and malignant meningiomas: a clinicopathological review. Neurosurgery 33:955–963

    PubMed  CAS  Google Scholar 

  3. 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

    CAS  Google Scholar 

  4. 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

    Article  PubMed  CAS  Google Scholar 

  5. 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

    Article  PubMed  CAS  Google Scholar 

  6. Knopp EA, Cha S, Johnson G, Mazumdar A et al (1999) Glial neoplasms: dynamic contrast-enhanced T2*-weighted MR imaging. Radiology 211:791–798

    PubMed  CAS  Google Scholar 

  7. 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

    PubMed  Google Scholar 

  8. 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

    Article  PubMed  CAS  Google Scholar 

  9. Zee CS, Chen T, Hinton DR et al (1995) Magnetic resonance imaging of cystic meningiomas and its surgical implications. Neurosurgery 36:482–488

    Article  PubMed  CAS  Google Scholar 

  10. Perry A, Stafford SL, Scheithauer BW et al (1997) Meningioma grading: an analysis of histologic parameters. Am J Surg Pathol 21:1455–1465

    Article  PubMed  CAS  Google Scholar 

  11. Buetow MP, Buetow PC, Smirniotopoulos JG (1991) Typical, atypical and misleading features in meningioma. Radiographics 11:1087–1106

    PubMed  CAS  Google Scholar 

  12. Guermazi A, Lafitte F, Miaux Y, Adem C, Bonneville JF, Chiras J (2005) The dural tail sign – beyond meningioma. Clin Radiol 60:171–188

    Article  PubMed  CAS  Google Scholar 

  13. 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

    Article  PubMed  CAS  Google Scholar 

  14. Carvalho GA, Vorkapic P, Biewener G, Samii M (1997) Cystic meningiomas resembling glial tumors. Surg Neurol 47:284–289

    Article  PubMed  CAS  Google Scholar 

  15. 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

    PubMed  Google Scholar 

  16. Petrella JR, Provenzale JM (2000) MR perfusion imaging of the brain: techniques and applications. AJR Am J Roentgenol 175:207–219

    PubMed  CAS  Google Scholar 

  17. 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

    PubMed  CAS  Google Scholar 

  18. 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

    Article  PubMed  CAS  Google Scholar 

  19. 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

    Article  PubMed  CAS  Google Scholar 

  20. 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

    CAS  Google Scholar 

  21. 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

    Article  PubMed  CAS  Google Scholar 

  22. 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

    PubMed  CAS  Google Scholar 

  23. 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

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Bahattin Hakyemez.

Additional information

Conflict of interest statement

We declare that we have no conflict of interest.

Rights and permissions

Reprints 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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-006-0115-y

Keywords

Navigation