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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 multiple microcystic pattern. (a, b) DWI and T2WI demonstrated a low signal intensity nodule in the left parietal cortex and multiple small cysts surrounding it. (c) On post-contrast MRI, the nodule was remarkably enhanced. (d) Microscopically, fibroblast-like spindle cells were arranged in a spiral shape around multiple vessels, and the cortical neurons were entrapped within the lesion.
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Fig3: Cystic meningioangiomatosis with a multiple microcystic pattern. (a, b) DWI and T2WI demonstrated a low signal intensity nodule in the left parietal cortex and multiple small cysts surrounding it. (c) On post-contrast MRI, the nodule was remarkably enhanced. (d) Microscopically, fibroblast-like spindle cells were arranged in a spiral shape around multiple vessels, and the cortical neurons were entrapped within the lesion.

Mentions: A 9-year-old girl suffered from an involuntary convulsion in her right limb for 1 month. Physical examination showed no positive signs. On non-enhanced MRI, a solid nodule 11 mm in diameter was found in the cortex of the left parietal lobe, demonstrating low signal intensity on DWI and T2WI (Figure 3a,b). Multiple small cysts were around the nodule. There was a slight mass effect and surrounding edema. After Gd-DTPA administration, the nodule was remarkably enhanced (Figure 3c). The preoperative diagnosis was ganglioglioma.Figure 3


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 multiple microcystic pattern. (a, b) DWI and T2WI demonstrated a low signal intensity nodule in the left parietal cortex and multiple small cysts surrounding it. (c) On post-contrast MRI, the nodule was remarkably enhanced. (d) Microscopically, fibroblast-like spindle cells were arranged in a spiral shape around multiple vessels, and the cortical neurons were entrapped within the lesion.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Fig3: Cystic meningioangiomatosis with a multiple microcystic pattern. (a, b) DWI and T2WI demonstrated a low signal intensity nodule in the left parietal cortex and multiple small cysts surrounding it. (c) On post-contrast MRI, the nodule was remarkably enhanced. (d) Microscopically, fibroblast-like spindle cells were arranged in a spiral shape around multiple vessels, and the cortical neurons were entrapped within the lesion.
Mentions: A 9-year-old girl suffered from an involuntary convulsion in her right limb for 1 month. Physical examination showed no positive signs. On non-enhanced MRI, a solid nodule 11 mm in diameter was found in the cortex of the left parietal lobe, demonstrating low signal intensity on DWI and T2WI (Figure 3a,b). Multiple small cysts were around the nodule. There was a slight mass effect and surrounding edema. After Gd-DTPA administration, the nodule was remarkably enhanced (Figure 3c). The preoperative diagnosis was ganglioglioma.Figure 3

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