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{{Meningioma}}
{{Meningioma}}
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==Overview==
==Overview==
Magnetic resonance imaging (MRI): An MRI uses magnetic fields but it is a different type of image than what is produced by computed tomography (CT) and produces detailed images of the body. Like computed tomography (CT), a contrast agent may be injected into a patient’s vein to create a better picture. It is a very valuable test for meningioma.
[[MRI]] with [[gadolinium]] is the investigation of choice for the diagnosis of meningioma. On MRI, meningioma is characterized by a [[homogeneous]], well circumscribed, and extra-axial mass with a broad [[Dura mater|dural]] base. Other findings on [[Magnetic resonance imaging|MRI]] suggestive of meningioma include [[CSF]] [[vascular]] [[cleft]] sign, [[Dura mater|dural]] tail sign, and central [[necrosis]] or [[calcification]] that do not enhance. Meningiomas may appear different on T1 and T2-weighted sequence but with a few similarities.


==MRI==
==MRI==
Meningiomas are readily visualized on [[MRI]] with gadolinium attributed to the fact that meningiomas are extra axial and vascularized.
MRI
As is the case with most other intracranial pathology, MRI is the investigation of choice for the diagnosis and characterisation of meningiomas. When appearance and location is typical, the diagnosis can be made with a very high degree of certainty. In many instances however the appearances are atypical.
Meningiomas typically appear as extra-axial masses with a broad dural base. They are usually homogeneous and well circumscribed, although many variants are encountered.
Signal characteristics include:
    T1
        isointense: ~60-90% 3,8, 13
        somewhat hypointense: 10-40% compared to grey matter
    T1 C+ (Gd): usually intense and homogeneous enhancement
    T2
        isointense: ~50% 3,8,13
        hyperintense: 35-40%
            usually correlates with soft textures and hypervascular tumours 13
            very hyperintense lesions may represent the microcystic variant 12
        hypointense: 10-15% compared to grey matter and usually correlates with harder texture and more fibrous and calcified contents
    DWI: atypical and malignant subtypes may show greater than expected restricted diffusion although recent work suggests that this is not useful in prospectively predicting histological grade 15-16
    MR spectroscopy: Usually it does not play a significant role in diagnosis but can help distinguish meningiomas from mimics. Features include:
        increase in alanine (1.3-1.5 ppm)
        increased glutamine/glutamate
        increased choline (Cho): cellular tumour
        absent or significantly reduced N-acetylaspartate (NAA): non-neuronal origin
        absent or significantly reduced creatine (Cr)
    MR perfusion: it has good correlation between volume transfer constant (k-trans) and histological grade


Helpful signs include
Head [[Magnetic resonance imaging|MRI]] may be helpful in the diagnosis of meningioma. Findings on [[Magnetic resonance imaging|MRI]] suggestive of/diagnostic of meningioma include:<ref name="pmid24399610">{{cite journal| author=Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T| title=Magnetic resonance imaging of meningiomas: a pictorial review. | journal=Insights Imaging | year= 2014 | volume= 5 | issue= 1 | pages= 113-22 | pmid=24399610 | doi=10.1007/s13244-013-0302-4 | pmc=3948902 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=24399610  }} </ref>
*Lobular, extra axial masses with well-circumscribed margins
*Broad-based [[Dura mater|dural]] attachment
*Inward displacement of the cortical [[grey matter]]
*Meningioma en plaque: [[Tumor]] with a more infiltrating growth pattern over the [[Dura mater|dura]]
*Ardent, [[homogeneous]] enhancement after [[contrast]] administration
*In some cases, may have areas of central [[necrosis]] or [[calcification]] that do not enhance
*Peritumoral [[edema]]
*[[Dura mater|Dural]] tail: enhancement of the [[Dura mater|dura]] infiltrating away from the [[lesion]]
*A [[CSF]] [[cleft]] (may contain [[CSF]] or [[Cortical area|cortical]] [[Blood vessel|vessels]]) between the [[tumor]] and the underlying [[brain]] [[cortex]]
*Intratumoral and peritumoral [[Cyst|cysts]] in cystic meningiomas


    CSF vascular cleft sign, which is not specific for meningioma, but helps establish the mass to be extra-axial; loss of this can be seen in grade II and grade III which may suggest brain parenchyma invasion
*On T1-weighted sequence:
    dural tail seen in 60-72% 2 (note that a dural tail is also seen in other processes)
:* Isointensity to slight hypointensity relative to [[grey matter]]
    sunburst or spokewheel appearance of the vessels
:* Extensive [[Dura mater|dural]] thickening in meningioma en plaque
:* Uniform low signal intensity in microcystic meningiomas


Meningiomas typically narrow arteries which they encase. This is a useful sign to distinguish a meningioma from a pituitary macroadenoma which will not.
*On T2-weighted sequence:
:* Isointensity to slight hyperintensity relative to [[grey matter]]
:* [[Calcification]] showing as areas of low signal intensity
:* High signal intensity in microcystic meningiomas


Oedema can be seen and correlates with size, rapid growth, location (convexity and parasagittal > elsewhere), and invasion in the case of malignant meningiomas.
==Gallery==
[[File:Cerebellopontine-angle-meningioma-5.jpg|400px|thumb|left|MRI showing meningioma in the cerebellopontine angle [https://radiopaedia.org/articles/meningioma?lang=us source:Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. ]]]
<br style="clear:left" /> [[File:Cystic meningioma.jpg|400px|thumb|left|MRI showing cystic meningioma [https://radiopaedia.org/articles/meningioma?lang=us source:Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. ]]]
<br style="clear:left" />
[[File:Craniocervical-junction-meningioma.jpg|400px|thumb|left|MRI showing meningioma in the craniocervical junction [https://radiopaedia.org/articles/meningioma?lang=us source:Case courtesy of Dr Mohammad Taghi Niknejad, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. ]]]
<br style="clear:left" />
[[File:Multiple-meningiomas-1.jpg|400px|thumb|left|MRI showing multiple meningiomas [https://radiopaedia.org/articles/meningioma?lang=us source:Case courtesy of Dr Paresh K Desai , <a href="https://radiopaedia.org/">Radiopaedia.org</a>. ]]]
<br style="clear:left" />
[[File:Meningioma-with-dural-tail.jpg|400px|thumb|left|MRI showing meningioma with a dural tail [https://radiopaedia.org/articles/meningioma?lang=us source:Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. ]]]
<br style="clear:left" />
[[File:Intraventricular-meningioma-third-ventricle-1.jpg|400px|thumb|left|MRI showing a meningioma in the third ventricle [https://radiopaedia.org/articles/meningioma?lang=us source:Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>. ]]]
<br style="clear:left" />


==References==
==References==
{{reflist|2}}
{{reflist|1}}


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Latest revision as of 14:38, 10 September 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Ifeoma Odukwe, M.D. [2] Haytham Allaham, M.D. [3]

Overview

MRI with gadolinium is the investigation of choice for the diagnosis of meningioma. On MRI, meningioma is characterized by a homogeneous, well circumscribed, and extra-axial mass with a broad dural base. Other findings on MRI suggestive of meningioma include CSF vascular cleft sign, dural tail sign, and central necrosis or calcification that do not enhance. Meningiomas may appear different on T1 and T2-weighted sequence but with a few similarities.

MRI

Head MRI may be helpful in the diagnosis of meningioma. Findings on MRI suggestive of/diagnostic of meningioma include:[1]

  • On T1-weighted sequence:
  • Isointensity to slight hypointensity relative to grey matter
  • Extensive dural thickening in meningioma en plaque
  • Uniform low signal intensity in microcystic meningiomas
  • On T2-weighted sequence:
  • Isointensity to slight hyperintensity relative to grey matter
  • Calcification showing as areas of low signal intensity
  • High signal intensity in microcystic meningiomas

Gallery

MRI showing meningioma in the cerebellopontine angle source:Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.


MRI showing cystic meningioma source:Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.


MRI showing meningioma in the craniocervical junction source:Case courtesy of Dr Mohammad Taghi Niknejad, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.


MRI showing multiple meningiomas source:Case courtesy of Dr Paresh K Desai , <a href="https://radiopaedia.org/">Radiopaedia.org</a>.


MRI showing meningioma with a dural tail source:Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.


MRI showing a meningioma in the third ventricle source:Case courtesy of A.Prof Frank Gaillard, <a href="https://radiopaedia.org/">Radiopaedia.org</a>.


References

  1. Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T (2014). "Magnetic resonance imaging of meningiomas: a pictorial review". Insights Imaging. 5 (1): 113–22. doi:10.1007/s13244-013-0302-4. PMC 3948902. PMID 24399610.


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