Fibrous meningioma is a common subtype of meningioma. Contrast-enhanced scan typically shows evident homogeneous enhancement,while ring enhancement has not been described. In this article,we report a case of fibrous meningioma with ring enhancement in cerebellopontine angle region.
Cerebellopontine Angle ; diagnostic imaging ; pathology ; Humans ; Magnetic Resonance Imaging ; Meningeal Neoplasms ; diagnostic imaging ; Meningioma ; diagnostic imaging

Objective To analyze the radiological features of idiopathic pediatric meningiomas and explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery.Methods We retrospectively reviewed 29 cases of pathologically confirmed pediatric meningiomas with pre-operative magnetic resonance imaging in Beijing Tiantan Hospital from November 2014 to July 2018.We assessed the imaging features to explore their relationships with pathological grading,misdiagnoses,and blood loss during surgery. Results Among the 29 cases,7 intraparenchymal meningiomas,5 extraparenchymal meningiomas,4 ventricular meningiomas,and 1 transcranial meningioma were misdiagnosed.Tumor location was significantly associated with possibility of misdiagnoses(
Child ; Humans ; Magnetic Resonance Imaging ; Meningeal Neoplasms/diagnostic imaging* ; Meningioma/diagnostic imaging* ; Retrospective Studies

The diagnosis of atypical cystic meningioma is difficult because of the atypical MRI findings.This paper reported a case of atypical cystic meningioma and described the detailed MRI findings,which would provide valuable imaging evidence for the localization and classification of cystic meningioma.
Humans ; Magnetic Resonance Imaging ; Meningeal Neoplasms/diagnostic imaging* ; Meningioma/diagnostic imaging*

PURPOSE: The magnetic resonance(MR) appearance of 23 biopsy-proven meningiomas were retrospectively evaluated and correlated with histologic pattern ;fibroblastic, transitional, syncytial, angioblastic. MATERIALS AND METHODS: Twenty three patients with biopsy-proven meningiomas were examined with MR imaging over a 3 years period. Images were assessed for average T1, T2 intensity score(1-5), degree of edema, calcification, cyst formation or necrosis, and dural tail sign. RESULTS: Tl-weighted images showed only one significant correlation between fibroblastic type and angiobiastic type (p<0.04). Angioblastic type was more hypointense than gray matter(1.83/isointense to gray 3) on T1-weighted image. Syncytial and angioblastic tumors had average T2 intensity scores much higher than those of fibroblastic and transitional types. All three cases of angioblastic tumors had shown severe edema. Calcified lesions were much more common in transitional and fibroblastic types than in syncytial and angioblastic types. CONCLUSION: MRI is a helpful diagnostic imaging modality with good correlation between its MR findings and histologic patterns.
Diagnostic Imaging ; Edema ; Fibroblasts ; Humans ; Magnetic Resonance Imaging* ; Meningioma* ; Necrosis ; Retrospective Studies

Extradural spinal meningiomas are uncommon, and their pathophysiology is not entirely understood. Here, we present the case of a 49-year-old woman with low back and left leg pain of 5 years duration. Magnetic resonance imaging revealed a mass, 1.8-cm in size, with rim enhancement in the spinal canal at the T12 level and extending into the left T12-L1 foramen. In the surgical field, the mass presented with the characteristics of an extra-intradural spinal meningioma. The patient underwent a T12 total laminectomy. A linear durotomy was performed at the midline, and the intradural portion was removed. The extradural portion was not separable from the adjacent dura and the left T12 root, and it was removed by dural excision. Pathological examination confirmed the diagnosis of psammomatous meningioma. We also conducted a literature review of similar cases. Based on our experience with this case, we believe that it is important to clearly distinguish extradural meningiomas from other types of tumors as misdiagnosis can change the operative plan. The long term prognosis of extradural meningiomas is not clear but total excision is thought to be essential.
Diagnosis ; Diagnostic Errors ; Female ; Humans ; Laminectomy ; Leg ; Magnetic Resonance Imaging ; Meningioma* ; Middle Aged ; Prognosis ; Spinal Canal

OBJECTIVETo investigate the clinical value of CT perfusion in diagnosing and assessing intracranial neoplasms and tumor-like lesions.

METHODS16-slice helical CT perfusion imaging was performed in 56 patients who were clinically suspected to have intracranial neoplasm or tumor-like lesion. With a GE-Light Speed 16-slice helical CT scanner, routine plain-CT scanning was performed to localize the central slice of the lesion. Perfusion imaging was then carried out using cine scan technique to maintain a slice thickness of 5-10 mm, a total dose of 50-70 ml of contrast-medium at an injection flow rate of 3-5 ml/s, a delay time of 7 s and a total scan time of 50 s. The images were processed using perfusion software in an ADW 4.0 workstation, meanwhile, time-density curves (TDC) of different kinds of lesions were also produced and analyzed.

RESULTSThe pathological types in this series included: 29 gliomas (12 low-grade and 17 high-grade), 2 ependemomas, 2 hemangioblastomas, 1 medulloblastoma, 2 metastatic tumors, 1 lymphoma, 5 meningiomas, 2 schwannomas, 1 germinoma, 1 teratoma in the pineal region, 6 cavernous hemangiomas, 2 inflammatory granulomas, 1 tuberculoma, and 1 hyperplasia of the choroid plexus. TDC of high-grade glioma, low-grade glioma and meningioma was different from each other. The cerebral blood flow (CBF), cerebral blood volume (CBV), particularly, the permeability surface (PS) value of glioma was found to increase significantly with the escalation of tumor differentiation grade. In PS map, margin of the tumor could be clearly showed, which was very useful when hemorrhaging within the tumor occurred. CBF in meningioma was lower than that in high-grade glioma, but there was no statistical difference in CBV, MTT and PS between these two types of tumor. The features of intracranial cavernous hemangioma such as significant prolongation of MTT, different TDCs, and zero perfused areas were diverse on CTP image, which was helpful in differentiating it from the other lesions. The germinoma and teratoma had rather low CBF and CBV value, but a remarkably high PS value, furthermore, they showed a rapid escalated TDC with a slowly and continuously elevated platform. The perfusion features of schwannoma was concordant with its pathological findings. However, no visible specific feature of inflammatory lesion was found on CTP image in this series.

CONCLUSIONMulti-slice helical CT perfusion imaging may be helpful in revealing histopathological features and hemodynamic changes as well as differential diagnosis of intracranial neoplasms and tumor-like lesions. When combined with other image and clinical information, CTP can play an important role in pre-operative diagnosis and treatment planning for intracranial neoplasms and tumor-like lesions.

Brain ; blood supply ; Brain Neoplasms ; diagnosis ; diagnostic imaging ; Cerebrovascular Circulation ; Diagnosis, Differential ; Glioma ; diagnosis ; diagnostic imaging ; Hemangioma, Cavernous ; diagnosis ; diagnostic imaging ; Humans ; Meningeal Neoplasms ; diagnosis ; diagnostic imaging ; Meningioma ; diagnosis ; diagnostic imaging ; Reproducibility of Results ; Sensitivity and Specificity ; Tomography, Spiral Computed ; methods

BACKGROUNDHemangiopericytomas (HPCs) have a relentless tendency for local recurrence and metastases, differentiating between benign meningiomas and HPCs before surgery is important for both treatment planning and the prognosis appraisal. The purpose of this study was to evaluate the correlations between CT perfusion parameters and microvessel density (MVD) in extra-axial tumors and the possible role of CT perfusion imaging in preoperatively differentiating benign meningiomas and HPCs.

METHODSSeventeen patients with benign meningiomas and peritumoral edema, 12 patients with HPCs and peritumoral edema underwent 64-slice CT perfusion imaging pre-operation. Perfusion was calculated using the Patlak method. The quantitative parameters, include cerebral blood volume (CBV), permeability surface (PS) of parenchyma, peritumoral edema among benign meningiomas and HPCs were compared respectively. CBV and PS in parenchyma, peritumoral edema of benign meningiomas and HPCs were also compared to that of the contrallateral normal white matter respectively. The correlations between CBV, PS of tumoral parenchyma and MVD were examined.

RESULTSThe value of CBV and PS in parenchyma of HPCs were significantly higher than that of benign meningiomas (P < 0.05), while the values of CBV and PS in peritumoral edema of benign meningiomas and HPCs were not significantly different (P > 0.05). MVD in parenchyma of HPCs were significantly higher than that of benign meningiomas (P < 0.05). There were positive correlations between CBV and MVD (r = 0.648, P < 0.05), PS and MVD (r = 0.541, P < 0.05) respectively. Furthermore, the value of CBV and PS in parenchyma of benign meningiomas and HPCs were significantly higher than that of contrallateral normal white matter (P < 0.05), the value of CBV in peritumoral edema of benign meningiomas and HPCs were significantly lower than that of contrallateral normal white matter (P < 0.05), while the value of PS in peritumoral edema of benign meningiomas and HPCs were not significantly different with that of contrallateral normal white matter (P > 0.05).

CONCLUSIONSCT perfusion imaging can provide critical information on the vascularity of HPC and benign meningiomas. Determination of maximal CBV and corresponding PS values in the parenchyma may be useful in the preoperative differentiating HPC from benign meningiomas.

Adult ; Aged ; Female ; Hemangiopericytoma ; diagnosis ; diagnostic imaging ; Humans ; Immunohistochemistry ; Male ; Meningioma ; diagnosis ; diagnostic imaging ; Middle Aged ; Tomography, X-Ray Computed ; methods

Classical trigeminal neuralgia is characterized by recurrent attacks of lancinating pain in the trigeminal nerve distribution, and no cause of the symptoms can be identified, other than vascular compression. This type of injury may rarely be caused by identifiable conditions, including tumor in the cerebellopontine angle. If the patient is suspected for secondary trigeminal neuralgia, further evaluation is required to diagnose and treat correctly. We report a case of a 49-year-old woman with a 1-month history of facial pain, who was initially misdiagnosed as odontalgia, and even treated with the extraction of her molar teeth. This case with the review of secondary trigeminal neuralgia may highlight the difficulties of diagnosis, and the importance of early diagnostic imaging, when trigeminal neuralgia occurs with a brain tumor.
Brain Neoplasms ; Cerebellopontine Angle ; Diagnostic Imaging ; Facial Pain ; Female ; Humans ; Meningioma ; Molar ; Neuroma, Acoustic ; Tooth ; Toothache ; Trigeminal Nerve ; Trigeminal Neuralgia

OBJECTIVETo evaluate the three-dimensional CT angiography (3D-CTA) assisted suboccipital transtentorial approach (Poppen's approach) in the treatment of pineal region meningioma.

METHODSDuring the period of January 2005 to January 2010, 8 patients with pineal region meningioma were successfully treated using Poppen's approach through cerebral falx and tentorium. There were three male patients and five female patients were aged at a range of 41 - 64 years, average age was (54 ± 10) years. According to the Karnofsky performance scale (KPS), 5 patients' KPS scores were more than or equal to 80 and 3 were less than 80. MRI was used for the diagnosis of meningioma. 3D-CTA was applied to detect meningioma staining and blood supply. For preoperative concurrent hydrocephalus, follow-up observations were given. If hydrocephalus didn't get better or even became worse, ventriculoperitoneal shunt should be considered.

RESULTSAll the surgery were successfully performed, and venous complexes (VC) were well protected according to the CTA images. Out of the eight cases whose meningiomas were removed, one patient had got postoperative intracranial infection and recovered after given antibiotics. All patients were followed up for a period of 6 - 24 months. Preoperative concurrent hydrocephalus in 7 patients were improved. However, there was an aggravation of the hydrocephalus in one patient who was treated with ventriculoperitoneal shunt. The MRIs which were performed at the end of follow-up period, showed no recurrence of meningiomas, and preoperative symptoms were improved to varying degrees, 7 patients' KPS scores were more than or equal to 80 and 1 was less than 80. A χ(2) test was used to analyze and to make comparisons between preoperative and postoperative KPS. The significance was indicated (χ(2) = 1.33, P < 0.05).

CONCLUSIONSFor meningiomas in the pineal region, 3D-CTA is of great clinical value to distinguish the anatomic relationship among the meningioma, blood supply and VC. This case study has strongly supported using Poppen's approach assisted by 3D-CTA to proceed with the operation.

Adult ; Cerebral Angiography ; methods ; Female ; Follow-Up Studies ; Humans ; Imaging, Three-Dimensional ; Male ; Meningeal Neoplasms ; diagnostic imaging ; surgery ; Meningioma ; diagnostic imaging ; surgery ; Middle Aged ; Pineal Gland ; diagnostic imaging ; surgery ; Tomography, X-Ray Computed

Meningioma is a common intracranial tumor in adults. Pediatric cases account for approximately 1.5% of all intracranial meningiomas, and very few cases show malignant histological features. Primary pediatric malignant meningioma in the cerebellopontine angle is extremely uncommon. Herein, we report a 2-year-old girl with malignant meningioma in the cerebellopontine angle. The clinical features, diagnosis, and treatment protocol are discussed.
Cerebellar Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Cerebellopontine Angle ; Child, Preschool ; Female ; Follow-Up Studies ; Humans ; Meningeal Neoplasms ; diagnostic imaging ; metabolism ; pathology ; surgery ; Meningioma ; diagnostic imaging ; metabolism ; pathology ; surgery ; Mucin-1 ; metabolism ; Radiography ; S100 Proteins ; metabolism ; Vimentin ; metabolism