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Three cases of sporadic meningioangiomatosis with different imaging appearances: case report and review of the literature.

Sun Z, Jin F, Zhang J, Fu Y, Li W, Guo H, Zhang Y - World J Surg Oncol (2015)

Bottom Line: In case 3, a remarkably enhanced solid nodule was found in the cortex of the left parietal lobe with multiple small cysts surrounding it.However, all were pathologically diagnosed as MA.Although MA imaging diagnoses are difficult, several MRI signs may include specific characteristics, such as a flow void effect on T2WI and separating cysts in the cystic MA (as shown in our cases), gyriform hyperintensity on T2-fluid attenuated inversion recovery (FLAIR) sequence, and susceptibility artifacts on T2 gradient echo (GRE) sequences (as found in the literature).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tianjin Medical University General Hospital, No. 154, Anshan Dao Road, Heping District, Tianjin, 300052, People's Republic of China. dr_zhihuasun@sina.com.

ABSTRACT

Background: Meningioangiomatosis (MA) is a rare meningiovascular malformation or hamartomatous lesion in the central nervous system. Radiographic findings of MA may show a variety of characteristics according to different histological components. We present three cases of sporadic MA with different imaging appearances in an attempt to identify specific imaging characteristics.

Case presentation: In case 1, an irregular hyperdense solid mass was localized in the left middle cranial fossa, demonstrating low and equal signal intensity on T1-weighted imaging (T1WI; TR/TE 2,048.9 ms/26.1 ms), high signal intensity with multiple flow void effect on T2-weighted imaging (T2WI; TR/TE 4,000 ms/106.4 ms), and significant and homogeneous enhancement on post-contrast magnetic resonance imaging (MRI). In case 2, the lesion in the right insular lobe showed a cystic-mural nodule pattern. The cystic content demonstrated similar density or signal intensity as cerebrospinal fluid, while the mural nodule demonstrated equal density or signal intensity on computed tomography (CT) and MRI. On post-contrast MRI, the mural nodule showed significant enhancement, but the cystic wall and content showed no enhancement. In case 3, a remarkably enhanced solid nodule was found in the cortex of the left parietal lobe with multiple small cysts surrounding it. This nodule showed low signal intensity on T2WI and diffusion-weighted imaging (DWI; TR/TE 6,000 ms/96.8 ms, b = 1,000 s/mm(2)). The preoperative diagnoses of the above three cases were meningioma, hemangioblastoma, and ganglioglioma. However, all were pathologically diagnosed as MA.

Conclusion: The presented cases demonstrate that MA may present with solid and cystic imaging patterns, which may include large cystic-mural nodules and small intra- and extra-cystic patterns. Although MA imaging diagnoses are difficult, several MRI signs may include specific characteristics, such as a flow void effect on T2WI and separating cysts in the cystic MA (as shown in our cases), gyriform hyperintensity on T2-fluid attenuated inversion recovery (FLAIR) sequence, and susceptibility artifacts on T2 gradient echo (GRE) sequences (as found in the literature).

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Solid meningioangiomatosis. (a) CT scan showed an irregular mixed high-density mass in the left middle cranial fossa. (b) On T1WI, the lesion demonstrated low and equal signal intensity. (c) On T2WI, the lesion showed high signal intensity with a multiple flow void effect. (d) On post-contrast MRI, the lesion showed significant and homogeneous enhancement. (e, f) Microphotography of specimens showed extensive fibroblastic proliferation and an increased number of vessels surrounded by meningothelial cells.
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Fig1: Solid meningioangiomatosis. (a) CT scan showed an irregular mixed high-density mass in the left middle cranial fossa. (b) On T1WI, the lesion demonstrated low and equal signal intensity. (c) On T2WI, the lesion showed high signal intensity with a multiple flow void effect. (d) On post-contrast MRI, the lesion showed significant and homogeneous enhancement. (e, f) Microphotography of specimens showed extensive fibroblastic proliferation and an increased number of vessels surrounded by meningothelial cells.

Mentions: A 73-year-old female patient had a history of binocular diplopia for 1 week. Physical examination showed a limitation in abduction movement in the left eye. A head computed tomography (CT) scan showed an irregular mixed hyperdense mass in the left middle cranial fossa (Figure 1a). On magnetic resonance imaging (MRI), the lesion demonstrated low and equal signal intensity on T1-weighted imaging (T1WI; TR/TE 2,048.9 ms/26.1 ms) and high signal intensity with multiple flow void effect on T2-weighted imaging (T2WI; TR/TE 4,000 ms/106.4 ms) (Figure 1b,c). On post-contrast MRI, the lesion showed significant and homogeneous enhancement after gadolinium diethylenetriamine pentaacetate (Gd-DTPA) was administered. The margin between the lesion and the adjacent brain cortex was well demarcated, and there was no obvious mass effect. The preoperative diagnosis was meningioma.Figure 1


Three cases of sporadic meningioangiomatosis with different imaging appearances: case report and review of the literature.

Sun Z, Jin F, Zhang J, Fu Y, Li W, Guo H, Zhang Y - World J Surg Oncol (2015)

Solid meningioangiomatosis. (a) CT scan showed an irregular mixed high-density mass in the left middle cranial fossa. (b) On T1WI, the lesion demonstrated low and equal signal intensity. (c) On T2WI, the lesion showed high signal intensity with a multiple flow void effect. (d) On post-contrast MRI, the lesion showed significant and homogeneous enhancement. (e, f) Microphotography of specimens showed extensive fibroblastic proliferation and an increased number of vessels surrounded by meningothelial cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358853&req=5

Fig1: Solid meningioangiomatosis. (a) CT scan showed an irregular mixed high-density mass in the left middle cranial fossa. (b) On T1WI, the lesion demonstrated low and equal signal intensity. (c) On T2WI, the lesion showed high signal intensity with a multiple flow void effect. (d) On post-contrast MRI, the lesion showed significant and homogeneous enhancement. (e, f) Microphotography of specimens showed extensive fibroblastic proliferation and an increased number of vessels surrounded by meningothelial cells.
Mentions: A 73-year-old female patient had a history of binocular diplopia for 1 week. Physical examination showed a limitation in abduction movement in the left eye. A head computed tomography (CT) scan showed an irregular mixed hyperdense mass in the left middle cranial fossa (Figure 1a). On magnetic resonance imaging (MRI), the lesion demonstrated low and equal signal intensity on T1-weighted imaging (T1WI; TR/TE 2,048.9 ms/26.1 ms) and high signal intensity with multiple flow void effect on T2-weighted imaging (T2WI; TR/TE 4,000 ms/106.4 ms) (Figure 1b,c). On post-contrast MRI, the lesion showed significant and homogeneous enhancement after gadolinium diethylenetriamine pentaacetate (Gd-DTPA) was administered. The margin between the lesion and the adjacent brain cortex was well demarcated, and there was no obvious mass effect. The preoperative diagnosis was meningioma.Figure 1

Bottom Line: In case 3, a remarkably enhanced solid nodule was found in the cortex of the left parietal lobe with multiple small cysts surrounding it.However, all were pathologically diagnosed as MA.Although MA imaging diagnoses are difficult, several MRI signs may include specific characteristics, such as a flow void effect on T2WI and separating cysts in the cystic MA (as shown in our cases), gyriform hyperintensity on T2-fluid attenuated inversion recovery (FLAIR) sequence, and susceptibility artifacts on T2 gradient echo (GRE) sequences (as found in the literature).

View Article: PubMed Central - PubMed

Affiliation: Department of Radiology, Tianjin Medical University General Hospital, No. 154, Anshan Dao Road, Heping District, Tianjin, 300052, People's Republic of China. dr_zhihuasun@sina.com.

ABSTRACT

Background: Meningioangiomatosis (MA) is a rare meningiovascular malformation or hamartomatous lesion in the central nervous system. Radiographic findings of MA may show a variety of characteristics according to different histological components. We present three cases of sporadic MA with different imaging appearances in an attempt to identify specific imaging characteristics.

Case presentation: In case 1, an irregular hyperdense solid mass was localized in the left middle cranial fossa, demonstrating low and equal signal intensity on T1-weighted imaging (T1WI; TR/TE 2,048.9 ms/26.1 ms), high signal intensity with multiple flow void effect on T2-weighted imaging (T2WI; TR/TE 4,000 ms/106.4 ms), and significant and homogeneous enhancement on post-contrast magnetic resonance imaging (MRI). In case 2, the lesion in the right insular lobe showed a cystic-mural nodule pattern. The cystic content demonstrated similar density or signal intensity as cerebrospinal fluid, while the mural nodule demonstrated equal density or signal intensity on computed tomography (CT) and MRI. On post-contrast MRI, the mural nodule showed significant enhancement, but the cystic wall and content showed no enhancement. In case 3, a remarkably enhanced solid nodule was found in the cortex of the left parietal lobe with multiple small cysts surrounding it. This nodule showed low signal intensity on T2WI and diffusion-weighted imaging (DWI; TR/TE 6,000 ms/96.8 ms, b = 1,000 s/mm(2)). The preoperative diagnoses of the above three cases were meningioma, hemangioblastoma, and ganglioglioma. However, all were pathologically diagnosed as MA.

Conclusion: The presented cases demonstrate that MA may present with solid and cystic imaging patterns, which may include large cystic-mural nodules and small intra- and extra-cystic patterns. Although MA imaging diagnoses are difficult, several MRI signs may include specific characteristics, such as a flow void effect on T2WI and separating cysts in the cystic MA (as shown in our cases), gyriform hyperintensity on T2-fluid attenuated inversion recovery (FLAIR) sequence, and susceptibility artifacts on T2 gradient echo (GRE) sequences (as found in the literature).

Show MeSH
Related in: MedlinePlus