Imaging Features of Intracranial Meningiomas with Histopathological Correlation: A Relook into Old Disease

Background and Purpose: Imaging characteristics of meningiomas have been discussed previously in many studies; however complete imaging features involving general features, MRS and DWI of both typical and atypical meningiomas have been discussed in very few studies. CT and MR imaging findings in 46 cases of intracranial meningioma are reviewed to define specific imaging features. Methods: The present study was carried on 46 patients in the Department of Radiodiagnosis and Imaging, Institute of Medical Sciences, Banaras Hindu University during June 2009 to July 2011.The investigation was carried out by GE-VCT 64 Slice Scanner machine and Magnetic resonance imaging was contemplated using 1.5 Tesla SIEMENS-MAGNETOM AVANTO. CT and MR imaging studies were reviewed to characterize mass location, imaging characteristics, atypical features and advanced imaging features. Clinical presenting signs and symptoms were correlated with imaging findings. Results: a). Forty six cases of intra cranial meningiomas were studied prospectively in 24 women and 22men, aged 11 – 80 years. Meningiomas were stratified into typical and atypical and also depending upon intra cranial location. b). 73.91% of the cases in showed supratentorial location, rest were infratentorial (26.08%).CT/MRI revealed well defined margins in 84.78% with homogenous consistency in 73.91% of lesions. Foci of necrosis were noted in 32.60% of cases and 15.22% of cases showed calcification foci in meningioma. Sinus invasion noticed in 15.22% of cases, whereas adjacent bony reaction noticed in 30.43% of cases. c). Majority of Meningioma showed broad dural base (89.10%), adjacent white matter buckling (71.74%) and surrounding CSF cleft (52.17%). Displaced subarachnoid vessels were demonstrated in 30.43%, where as the pathognomonic dural tail was present in only 23.91% of the cases. d). All the cases of Meningioma demonstrated restriction on diffusion weighted sequences suggestive of high cellularity of the lesions. On CT angiography, neovascularity was noticed in 85.71% and tumor blush was noticed in 71.42% incidence. On MR Spectroscopy, all demonstrated choline peak and in one third cases alanine peak was discernible. Conclusion: In view of the observed evidence, it was concluded that understanding the classification, pathology and imaging appearance meningioma are essential for treatment planning. CT and MR imaging play indispensable role in the localization & characterization of these tumors, and MR have virtually yielded its position of dominance in characterizing these tumors. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 14-32 DOI: http://dx.doi.org/10.3126/njr.v3i1.8713

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Intracranial meningiomas: magnetic resonance imaging findings in 78 cases

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2007000400012 ◽

2007 ◽

Vol 65 (3a) ◽

pp. 610-614 ◽

Cited By ~ 12

Author(s):

Emerson L. Gasparetto ◽

Claudia da Costa Leite ◽

Leandro T. Lucato ◽

Cristiano Ventorin de Barros ◽

Sueli K.N. Marie ◽

...

Keyword(s):

Magnetic Resonance ◽

Mr Imaging ◽

High Signal ◽

Intracranial Meningioma ◽

Imaging Findings ◽

Contrast Administration ◽

Intracranial Meningiomas ◽

Dural Tail Sign ◽

Dural Tail ◽

Bone Infiltration

OBJECTIVE: To present the magnetic resonance (MR) imaging findings of 78 patients with meningiomas diagnosed in a single institution. METHOD: 78 patients with histological proven intracranial meningioma were studied. There were 52 female and 26 male patients (median=56 years). All MR imaging examinations were performed with 1.5-T MR imaging unit with standard protocol. The images were studied by two neuroradiologists, who reached the decisions regarding the findings by consensus. RESULTS: Most of the tumors showed low signal on T1- (60%) and high signl on T2- (68%) and FLAIR (69%) weighted images. Also, the lesions showed heterogeneous signal on T1 (60%), T2 (68%) and FLAIR (64%) sequences. After contrast administration, 83% (n=65) of the tumors presented acentuated and 17% (n=13) showed moderate enhancement. The tumors were located in the frontal lobe in 44% of the cases, in the parietal lobe in 35%, the occipital lobe in 19% and the temporal lobe in 12% of the patients. Areas of vasogenic edema around the tumors were seen in 90% of the cases. Twenty six per cent of the cases showed bone infiltration, and the dural tail sign was seen in 59% of the tumors. CONCLUSION: Intracranial meningiomas usually show heterogeneous low signal on T1- and high signal on T2-weighted and FLAIR images, with intense enhancement after contrast administration. The frontal and parietal lobes are commonly affected. In addition, brain edema, dural tail sign and bone infiltration are the most frequent associated findings.

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Hemorrhagic and nonhemorrhagic Rathke cleft cysts mimicking pituitary apoplexy

Journal of Neurosurgery ◽

10.3171/jns/2008/108/01/0003 ◽

2008 ◽

Vol 108 (1) ◽

pp. 3-8 ◽

Cited By ~ 46

Author(s):

Mandy J. Binning ◽

James K. Liu ◽

John Gannon ◽

Anne G. Osborn ◽

William T. Couldwell

Keyword(s):

Mr Imaging ◽

Pituitary Tumor ◽

Pituitary Apoplexy ◽

Pituitary Tumors ◽

Imaging Features ◽

Mr Images ◽

Acute Hemorrhage ◽

Consistent Finding ◽

Imaging Characteristics ◽

Intracystic Hemorrhage

Object Rathke cleft cysts (RCCs) are infrequently symptomatic, and apoplexy is one of the most unusual presentations. Only a few cases of apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated pituitary apoplexy, both with and without intracystic hemorrhage. Methods The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with pituitary apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal intensities in the sellar masses suggestive of a hemorrhagic pituitary tumor. In all patients there was a presumed clinical diagnosis of pituitary tumor apoplexy and an imaging-documented diagnosis of hemorrhagic pituitary tumor. Results All 6 patients underwent transsphenoidal resection to treat the suspected pituitary apoplexy. Intraoperative and histopathological findings were consistent with the diagnosis of an RCC in all cases. Only 2 cases showed evidence of hemorrhage intraoperatively. In all cases, an intracystic nodule was found within the RCC at surgery, and this intracystic nodule was present on the initial MR imaging when retrospectively reviewed. The imaging characteristics of the intracystic nodules were similar to those of acute hemorrhage seen in cases of pituitary apoplexy. Conclusions The clinical and imaging features of RCCs appear similar to those of hemorrhagic pituitary tumors, making them often indistinguishable from pituitary apoplexy.

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Mr imaging of primary non-Hodgkin's breast lymphoma

Acta Radiologica ◽

10.1080/02841859709171251 ◽

1997 ◽

Vol 38 (1) ◽

pp. 104-107

Author(s):

S. Mussurakis ◽

P. J. Carleton ◽

L. W. Turnbull

Keyword(s):

Mr Imaging ◽

Large Mass ◽

Invasive Cancer ◽

Imaging Features ◽

Conventional Imaging ◽

Imaging Findings ◽

Dynamic Data ◽

Breast Lymphoma ◽

The Masses ◽

Tumour Differentiation

In this report we describe the MR imaging findings, including dynamic data, in a patient with primary non-Hodgkin's lymphoma of the breast. The precontrast T1-weighted sequence showed several hypointense, ill-defined, non-spiculated masses. In the T2-weighted images the masses showed a hyperintense halo. In the dynamic and postcontrast sequences all lesions enhanced markedly, and a further large mass was discovered. In comparison to mammography and sonography, only MR imaging identified the multicentric extent of the tumour. Differentiation from invasive cancer, based on either MR or conventional imaging features, was not possible.

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Use of intraoperative sodium tetradecyl sulfate for the treatment of a spinal epidural hemangioma

Journal of Neurosurgery Spine ◽

10.3171/spi-07/08/264 ◽

2007 ◽

Vol 7 (2) ◽

pp. 264-269 ◽

Cited By ~ 4

Author(s):

Mirza N. Baig ◽

Syed Saquib ◽

Greg Christoforidis ◽

Louis P. Caragine

Keyword(s):

Mr Imaging ◽

Gross Total Resection ◽

Treatment Modalities ◽

Sodium Tetradecyl Sulfate ◽

Imaging Findings ◽

Total Resection ◽

Intraoperative Angiography ◽

Posterior Aspect ◽

Imaging Characteristics ◽

Spinal Epidural

✓Spinal hemangiomas can be categorized into three different groups based on location. Vertebral body (VB) heman-giomas are frequent incidental findings on magnetic resonance (MR) imaging. There is a subdivision of these with spinal epidural extension that have been reported in the literature. Spinal hemangiomas can also be epidural without VB involvement; these are extremely rare with few reported cases in the thoracic epidural spinal column. The diagnosis and imaging characteristics as well as the surgical tools used in gross-total resection of spinal epidural hemangioma are not well understood. The authors present a detailed characterization of a spinal epidural hemangioma in a 30-year-old woman who presented with complaints of gradual onset of low-back pain that worsened over 1 year. The MR imaging findings indicated a large L2–S1 epidural spinal mass causing thecal sac compression. The patient underwent an L2–S1 laminectomy, and a vascular extradural mass was noted on the posterior aspect of the dura mater. Preoperative spinal angiography as well as intraoperative angiography was performed. Total resection of the tumor was achieved using intraoperative embolization with sodium tetradecyl sulfate and microscopic dissection. The postoperative MR imaging findings and clinical outcome were excellent. The findings and use of sodium tetradecyl sulfate in gross-total resection are discussed. The authors also review treatment modalities and demonstrate the utility and effectiveness of intraoperative sodium tetradecyl sulfate in gross-total resection of large difficult spinal epidural hemangiomas.

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Unusual CT and MR Imaging Characteristics of Splenic Lymphoma

Case Reports in Oncological Medicine ◽

10.1155/2011/298357 ◽

2011 ◽

Vol 2011 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Chhavi Kaushik ◽

Nitin Relia ◽

Kedar Jambhekar ◽

Tarun Pandey

Keyword(s):

Mr Imaging ◽

English Literature ◽

Vascular Pathology ◽

Low Density ◽

Imaging Features ◽

Focal Lesions ◽

Imaging Characteristics ◽

Splenic Lymphoma ◽

Proven Case ◽

Common Malignancy

Lymphoma is the most common malignancy of the spleen. The imaging features of splenic lymphoma are nonspecific and mostly lymphomas present as a diffusely enlarged spleen. Focal lesions are described but remain of low density or intensity on CT or MRI, respectively. We describe a histologically proven case of splenic lymphoma that showed an atypical hyperdense/hyperenhancing appearance on imaging suspicious for a vascular pathology. To the best of our knowledge and based on review of English literature, such an appearance of splenic lymphoma is extremely unusual and rare.

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Interpretation of magnetic resonance images in diffuse intrinsic pontine glioma: a survey of pediatric neurosurgeons

Journal of Neurosurgery Pediatrics ◽

10.3171/2011.4.peds1180 ◽

2011 ◽

Vol 8 (1) ◽

pp. 97-102 ◽

Cited By ~ 38

Author(s):

Todd C. Hankinson ◽

Elizabeth J. Campagna ◽

Nicholas K. Foreman ◽

Michael H. Handler

Keyword(s):

Mr Imaging ◽

Online Survey ◽

Multicenter Trial ◽

Diffuse Intrinsic Pontine Glioma ◽

Magnetic Resonance Images ◽

Imaging Findings ◽

Mr Images ◽

Pontine Glioma ◽

Tumor Biopsy ◽

Imaging Characteristics

Object The current management paradigm for children with newly diagnosed diffuse intrinsic pontine glioma (DIPG) is to establish a diagnosis and begin therapy based on MR imaging findings correlated with an appropriate clinical presentation, and without a tissue diagnosis. This strategy assumes that pediatric neurosurgeons and neurooncologists uniformly interpret MR imaging findings in this population. This study sought to examine the consistency of North American pediatric neurosurgeons in assessing MR images in this patient population, and in their surgical plans based on the interpretation of those images. Methods The authors created an online survey and invited all members of the American Society of Pediatric Neurosurgeons and the American Association of Neurological Surgeons/Congress of Neurological Surgeons Joint Section for Pediatric Neurosurgery to participate. The survey consisted of 58 questions, and 48 pertained to representative MR images from 16 children who presented to The Children's Hospital of Colorado with diffuse pontine tumors. Based on the imaging presented and a standard clinical scenario, the respondent was asked if she or he believed a lesion to be “typical” or “atypical,” whether she or he would biopsy the lesion, and what surgical approach would be chosen. The remaining 10 questions pertained to respondent demographics and his or her practice regarding tissue preservation and interest in participating in a multicenter trial that included tumor biopsy in selected cases. Rates at which each lesion was considered to be typical or atypical and rates of recommended biopsy were calculated. Results Surveys were received by 269 individuals. Eighty-six responses were received (32.0%). No tumor was judged to be either typical or atypical by all respondents. Individual surgeons varied widely regarding how many of the tumors were judged as typical or warranted a biopsy. The percentage of respondents who disagreed with the majority opinion regarding whether a tumor qualified as typical ranged from 2.3% to 48.8%, with a median of 28.6%. More than 75% agreement regarding whether a tumor was typical or atypical was found in 7 (43.8%) of 16 cases. The κ statistic regarding typicality was 0.297 ± 0.0004 (mean ± SEM), implying only fair agreement. For every tumor, at least 1 respondent who believed the lesion to be typical in appearance would nevertheless biopsy the lesion. Of those respondents who considered a lesion to be typical, a median of 5.1% (range 1.2%–66.7%) would choose to biopsy this lesion. Of those respondents who considered a lesion atypical, a median of 18.3% (range 3.7%–100%) would choose not to biopsy the lesion. Of 85 responses to the question, “Would you be willing to biopsy a typical diffuse pontine glioma as a part of a multicenter trial?,” 59 (69.4%) of 85 respondents answered that they would. Conclusions Although making a diagnosis based on radiographic evidence alone represents a well-established management paradigm for children with suspected DIPG, this study demonstrates considerable inconsistency on the part of pediatric neurosurgeons in the application of this strategy to individual patients. As such, the practice of diagnosing DIPG based on imaging characteristics and clinical history alone does not reach the appropriate threshold to be considered a standard of care.

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Masses, Malignancy, and Mimics: CT and MR Imaging of the Sinonasal Cavity

Neurographics ◽

10.3174/ng.2000030 ◽

2021 ◽

Vol 11 (2) ◽

pp. 80-95

Author(s):

E.K. Funk ◽

S.M. Dorros ◽

A.S. Deconde ◽

M.A. McDonald

Keyword(s):

Mr Imaging ◽

Surgical Management ◽

Inflammatory Disease ◽

Learning Objectives ◽

Disease Spread ◽

Imaging Features ◽

Imaging Findings ◽

Sinonasal Malignancies ◽

Clinical Presentations ◽

Disease Staging

Although sinonasal malignancies are relatively rare entities, the frequency of sinus imaging ensures that most radiologists will encounter an unsuspected sinonasal neoplasm at some point in their career. Given that the initial clinical presentations are often nonspecific and may mimic inflammatory rhinosinusitis, it is essential that the practicing radiologist becomes familiar with the specific CT and MR imaging findings that should raise suspicion for an underlying neoplasm. In the course of this review, we highlight the imaging features of a spectrum of sinonasal neoplasms, both benign and malignant, with emphasis on the distinct and complementary roles of CT and MR imaging in the differentiation from common inflammatory disease. We also highlight key anatomic relationships crucial to identifying routes of disease spread with an eye toward disease staging and surgical management.Learning Objectives: To familiarize the practicing radiologist with the key imaging features that should raise suspicion for an underlying sinonasal malignancy and to understand the complementary roles of CT and MR imaging in evaluating routes of locoregional and perineural disease spread.

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Lhermitte-Duclos disease mimicking adult-onset aqueductal stenosis

Journal of Neurosurgery ◽

10.3171/jns.1994.80.6.1095 ◽

1994 ◽

Vol 80 (6) ◽

pp. 1095-1098 ◽

Cited By ~ 5

Author(s):

Shah N. Siddiqi ◽

Michael G. Fehlings

Keyword(s):

Mr Imaging ◽

Benign Lesion ◽

Aqueductal Stenosis ◽

Cerebellar Hemisphere ◽

Imaging Features ◽

Adult Onset ◽

Full Spectrum ◽

Content Type ◽

Weighted Image ◽

Imaging Characteristics

✓ Lhermitte-Duclos disease is a rare lesion characterized by enlarged cerebellar folia containing abnormal ganglion cells. This case report describes a 51-year-old woman who was initially misdiagnosed as having adult-onset aqueductal stenosis. There were no abnormal findings on computerized tomography (CT), but subsequent magnetic resonance (MR) imaging showed a midline cerebellar lesion extending to the brain stem. This is a unique case of Lhermitte-Duclos disease arising within the cerebellar vermis. The characteristic feature of an enlarged cerebellar hemisphere is absent on CT scans; thus MR imaging is needed to confirm the diagnosis. If diagnosed late, this generally benign lesion becomes difficult to resect totally and has a poorer prognosis. Only two reports have mentioned the MR imaging characteristics of Lhermitte-Duclos disease; both described only T2-weighted images. This case illustrates the full spectrum of MR imaging features of this disease. Both T1- and T2-weighted studies showed enlarged cerebellar folia within the lesion. The T1-weighted image showed a mixed iso- and hypodense signal and the T2-weighted image a homogeneously increased signal; with gadolinium administration the lesion did not enhance. The latter feature supports the theory that this disease is a hamartoma rather than a tumor.

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Spectrum of MR imaging findings of sinonasal mucormycosis in post COVID-19 patients

British Journal of Radiology ◽

10.1259/bjr.20210648 ◽

2021 ◽

Author(s):

Sushen Kumar Kondapavuluri ◽

Varun Kumar reddy Anchala ◽

Shohyle Bandlapalli ◽

Rajani Gorantla ◽

Ankamma Rao Danaboyina ◽

...

Keyword(s):

Early Intervention ◽

Mr Imaging ◽

Imaging Features ◽

Imaging Findings ◽

Radiological Findings ◽

Secondary Infections ◽

Adjacent Structures ◽

Rapid Spread ◽

Extent Of Disease ◽

Diagnostic Pitfalls

During rapid spread of coronavirus disease (COVID-19) globally, ever since WHO declared COVID-19 as pandemic, there have been various patterns of disease in terms of diagnosis, management and complications. Secondary infections are reportedly common in hospitalized and severely ill COVID-19 patients among which fungal being 10 times more common. Mucormycosis is amongst the most lethal form of Zygormycosis occurring in post COVID-19 patients. A varied patterns of disease involvement and spectrum of imaging features are observed in patients with mucormycosis in post COVID-19 patients. MRI has better efficacy than CT in detecting early invasion of mucormycosis. The goal of this review is to familiarize radiologists about the MR imaging spectrum of mucormycosis in post COVID-19 patients with potential diagnostic pitfalls in CT. Advances in knowledge: Radiological findings of mucormycosis in post COVID-19 patients show varied patterns of disease involvement and spectrum of imaging features. One should not solely rely on CT imaging to detect the extent of disease. MRI helps in early and accurate detection of invasion into adjacent structures and so helpful in early intervention.

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