Meningiomas: MR and histopathologic features

The magnetic resonance (MR) appearances of 40 biopsy-proved meningiomas were blindly evaluated and correlated with their predominant histologic pattern--fibroblastic, transitional, syncytial, angioblastic, or mixed. T1-weighted images were not particularly useful in discriminating pathologic subtype, because most tumors were isointense with or hypointense to cortex regardless of histologic type. Signal intensity and features on T2-weighted images strongly correlated with histopathologic findings in over 75% of cases, however. Meningiomas markedly hypointense to cortex on T2-weighted images (seven of 40 cases) were composed predominantly of fibroblastic or transitional elements, while markedly hyperintense meningiomas (14 of 40 cases) demonstrated predominance of syncytial or angioblastic elements. Consideration of secondary features visible at MR imaging (degree of edema, cyst formation, presence of calcium aggregates) led to a more specific histologic prediction in over half of the remaining isointense tumors. The varied MR appearance of meningiomas has a clear histologic basis, and crude prediction of pathologic subtype is possible in over three-fourths of cases.