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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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Cystic meningioangiomatosis with a cystic-mural nodule pattern. (a) CT scan showed a cystic-mural nodule lesion in the right insular lobe. (b-d) In non-enhanced MRI, the cystic content demonstrated similar signal intensity as cerebrospinal fluid (CSF), while the mural nodule demonstrated iso-signal intensity on T1WI, T2WI, and DWI. (e) On post-contrast MRI, the mural nodule demonstrated significant enhancement, while the cystic wall and content showed no enhancement. (f) Pathological examination showed perivascular spindle-cell proliferation.
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Fig2: Cystic meningioangiomatosis with a cystic-mural nodule pattern. (a) CT scan showed a cystic-mural nodule lesion in the right insular lobe. (b-d) In non-enhanced MRI, the cystic content demonstrated similar signal intensity as cerebrospinal fluid (CSF), while the mural nodule demonstrated iso-signal intensity on T1WI, T2WI, and DWI. (e) On post-contrast MRI, the mural nodule demonstrated significant enhancement, while the cystic wall and content showed no enhancement. (f) Pathological examination showed perivascular spindle-cell proliferation.

Mentions: A 23-year-old male patient presented with left hemianesthesia for more than 2 years. Physical examination showed hypesthesia and slight ataxia on the left side, and a decrease of graphics and two-point discrimination sensation. A cystic-mural nodule lesion was localized in the right insular lobe on head plain CT (Figure 2a). The cystic portion had low density with 9 Hu, and the mural nodule was isodense with 35 Hu. The cystic content demonstrated similar signal intensity as cerebrospinal fluid (CSF), while the mural nodule demonstrated iso-signal intensity on T1WI, T2WI, and diffusion-weighted imaging (DWI; TR/TE 6,000 ms/96.8 ms, b = 1,000 s/mm2) (Figure 2b,c,d). On post-contrast MRI, the mural nodule showed significant enhancement, but the cystic wall and content demonstrated no enhancement (Figure 2e). The adjacent brain parenchyma and sulci were compressed and deformed, but there was no edema around the tumor. The preoperative diagnosis was hemangioblastoma.Figure 2


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)

Cystic meningioangiomatosis with a cystic-mural nodule pattern. (a) CT scan showed a cystic-mural nodule lesion in the right insular lobe. (b-d) In non-enhanced MRI, the cystic content demonstrated similar signal intensity as cerebrospinal fluid (CSF), while the mural nodule demonstrated iso-signal intensity on T1WI, T2WI, and DWI. (e) On post-contrast MRI, the mural nodule demonstrated significant enhancement, while the cystic wall and content showed no enhancement. (f) Pathological examination showed perivascular spindle-cell proliferation.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig2: Cystic meningioangiomatosis with a cystic-mural nodule pattern. (a) CT scan showed a cystic-mural nodule lesion in the right insular lobe. (b-d) In non-enhanced MRI, the cystic content demonstrated similar signal intensity as cerebrospinal fluid (CSF), while the mural nodule demonstrated iso-signal intensity on T1WI, T2WI, and DWI. (e) On post-contrast MRI, the mural nodule demonstrated significant enhancement, while the cystic wall and content showed no enhancement. (f) Pathological examination showed perivascular spindle-cell proliferation.
Mentions: A 23-year-old male patient presented with left hemianesthesia for more than 2 years. Physical examination showed hypesthesia and slight ataxia on the left side, and a decrease of graphics and two-point discrimination sensation. A cystic-mural nodule lesion was localized in the right insular lobe on head plain CT (Figure 2a). The cystic portion had low density with 9 Hu, and the mural nodule was isodense with 35 Hu. The cystic content demonstrated similar signal intensity as cerebrospinal fluid (CSF), while the mural nodule demonstrated iso-signal intensity on T1WI, T2WI, and diffusion-weighted imaging (DWI; TR/TE 6,000 ms/96.8 ms, b = 1,000 s/mm2) (Figure 2b,c,d). On post-contrast MRI, the mural nodule showed significant enhancement, but the cystic wall and content demonstrated no enhancement (Figure 2e). The adjacent brain parenchyma and sulci were compressed and deformed, but there was no edema around the tumor. The preoperative diagnosis was hemangioblastoma.Figure 2

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