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Contribution of perfusion-weighted magnetic resonance imaging in the differentiation of meningiomas and other extra-axial tumors: case reports and literature review.

Zimny A, Sasiadek M - J. Neurooncol. (2011)

Bottom Line: Apart from conventional MR examinations, all the patients also underwent perfusion-weighted imaging (PWI) using dynamic susceptibility contrast method on a 1.5 T MR unit (contrast: 0.3 mmol/kg, rate 5 ml/s).The article draws special attention to the usefulness of PWI in the differentiation of various extra-axial tumors and its contribution in reaching final correct diagnoses.In our opinion, PWI as an easy and quick to perform functional technique should be incorporated into the MR protocol of all intracranial tumors including extra-axial neoplasms.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland. abernac@wp.pl

ABSTRACT
We present six cases of extra-axial lesions: three meningiomas [including one intraventricular and one cerebellopontine angle (CPA) meningioma], one dural metastasis, one CPA schwannoma and one choroid plexus papilloma which were chosen from a larger cohort of extra-axial tumors evaluated in our institution. Apart from conventional MR examinations, all the patients also underwent perfusion-weighted imaging (PWI) using dynamic susceptibility contrast method on a 1.5 T MR unit (contrast: 0.3 mmol/kg, rate 5 ml/s). Though the presented tumors showed very similar appearance on conventional MR images, they differed significantly in perfusion examinations. The article draws special attention to the usefulness of PWI in the differentiation of various extra-axial tumors and its contribution in reaching final correct diagnoses. Finding a dural lesion with low perfusion parameters strongly argues against the diagnosis of meningioma and should raise a suspicion of a dural metastasis. In cases of CPA tumors, a lesion with low relative cerebral blood volume values should be suspected to be schwannoma, allowing exclusion of meningioma to be made. In intraventricular tumors arising from choroid plexus, low perfusion parameters can exclude a diagnosis of meningioma. In our opinion, PWI as an easy and quick to perform functional technique should be incorporated into the MR protocol of all intracranial tumors including extra-axial neoplasms.

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Two CPA tumors: T1 post-contrast (a, d) images, CBV maps (b, e) and time-intensity curves (c, f). a–c Typical schwannoma with low perfusion parameters (blue coloring) and the time-intensity curve returning to the baseline (violet curve). d–f Meningioma with intracanalicular enhancing part showing typical hyperperfusion (red coloring) and the time-intensity curve with no return to the baseline (violet curve)
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Fig2: Two CPA tumors: T1 post-contrast (a, d) images, CBV maps (b, e) and time-intensity curves (c, f). a–c Typical schwannoma with low perfusion parameters (blue coloring) and the time-intensity curve returning to the baseline (violet curve). d–f Meningioma with intracanalicular enhancing part showing typical hyperperfusion (red coloring) and the time-intensity curve with no return to the baseline (violet curve)

Mentions: A 58-year-old male. MR images demonstrated a meningioma-like dural tumor located along tentorium on the right side in the posterior cranial fossa. The lesion showed signal intensity similar to cerebellar parenchyma on T1-weighted images, while on T2-weighted images the tumor was hypointense. Mild peritumoral edema was also seen. After contrast injection, heterogeneous enhancement and the dural tail sign were noticed. No other enhancing pathological lesions were found within the brain. Perfusion maps showed very low rCBV values (rCBV = 0.4) with the time-intensity curve returning to the baseline. The patient did not have any history of a neoplastic disease. Gross pathology revealed dural metastasis of the squamous cell carcinoma of the lungs.


Contribution of perfusion-weighted magnetic resonance imaging in the differentiation of meningiomas and other extra-axial tumors: case reports and literature review.

Zimny A, Sasiadek M - J. Neurooncol. (2011)

Two CPA tumors: T1 post-contrast (a, d) images, CBV maps (b, e) and time-intensity curves (c, f). a–c Typical schwannoma with low perfusion parameters (blue coloring) and the time-intensity curve returning to the baseline (violet curve). d–f Meningioma with intracanalicular enhancing part showing typical hyperperfusion (red coloring) and the time-intensity curve with no return to the baseline (violet curve)
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3116130&req=5

Fig2: Two CPA tumors: T1 post-contrast (a, d) images, CBV maps (b, e) and time-intensity curves (c, f). a–c Typical schwannoma with low perfusion parameters (blue coloring) and the time-intensity curve returning to the baseline (violet curve). d–f Meningioma with intracanalicular enhancing part showing typical hyperperfusion (red coloring) and the time-intensity curve with no return to the baseline (violet curve)
Mentions: A 58-year-old male. MR images demonstrated a meningioma-like dural tumor located along tentorium on the right side in the posterior cranial fossa. The lesion showed signal intensity similar to cerebellar parenchyma on T1-weighted images, while on T2-weighted images the tumor was hypointense. Mild peritumoral edema was also seen. After contrast injection, heterogeneous enhancement and the dural tail sign were noticed. No other enhancing pathological lesions were found within the brain. Perfusion maps showed very low rCBV values (rCBV = 0.4) with the time-intensity curve returning to the baseline. The patient did not have any history of a neoplastic disease. Gross pathology revealed dural metastasis of the squamous cell carcinoma of the lungs.

Bottom Line: Apart from conventional MR examinations, all the patients also underwent perfusion-weighted imaging (PWI) using dynamic susceptibility contrast method on a 1.5 T MR unit (contrast: 0.3 mmol/kg, rate 5 ml/s).The article draws special attention to the usefulness of PWI in the differentiation of various extra-axial tumors and its contribution in reaching final correct diagnoses.In our opinion, PWI as an easy and quick to perform functional technique should be incorporated into the MR protocol of all intracranial tumors including extra-axial neoplasms.

View Article: PubMed Central - PubMed

Affiliation: Department of General and Interventional Radiology and Neuroradiology, Wroclaw Medical University, Borowska Street 213, 50-556 Wroclaw, Poland. abernac@wp.pl

ABSTRACT
We present six cases of extra-axial lesions: three meningiomas [including one intraventricular and one cerebellopontine angle (CPA) meningioma], one dural metastasis, one CPA schwannoma and one choroid plexus papilloma which were chosen from a larger cohort of extra-axial tumors evaluated in our institution. Apart from conventional MR examinations, all the patients also underwent perfusion-weighted imaging (PWI) using dynamic susceptibility contrast method on a 1.5 T MR unit (contrast: 0.3 mmol/kg, rate 5 ml/s). Though the presented tumors showed very similar appearance on conventional MR images, they differed significantly in perfusion examinations. The article draws special attention to the usefulness of PWI in the differentiation of various extra-axial tumors and its contribution in reaching final correct diagnoses. Finding a dural lesion with low perfusion parameters strongly argues against the diagnosis of meningioma and should raise a suspicion of a dural metastasis. In cases of CPA tumors, a lesion with low relative cerebral blood volume values should be suspected to be schwannoma, allowing exclusion of meningioma to be made. In intraventricular tumors arising from choroid plexus, low perfusion parameters can exclude a diagnosis of meningioma. In our opinion, PWI as an easy and quick to perform functional technique should be incorporated into the MR protocol of all intracranial tumors including extra-axial neoplasms.

Show MeSH
Related in: MedlinePlus