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Cranial and Spinal Meninges

Cranial and Spinal Meninges

The cranial and spinal meninges are complex protective structures surrounding the central nervous system (CNS), consisting of the brain and spinal cord. These meninges consist of the dura mater, the arachnoid mater, and the pia mater. They protect the CNS, provide structural support, and aid in circulating cerebrospinal fluid (CSF).
Cranial Meninges
These meningeal layers cover the cranium. The dura mater is the outermost layer of cranial meninges. It is a thick and durable membrane of dense...

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Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery

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Dural-based lesions: is it a meningioma?

Vitor Nagai Yamaki¹, Luis Filipe de Souza Godoy², Gabriela Alencar Bandeira²

¹Division of Neurological Surgery, Universidade de Sao Paulo, Rua Dr Eneas de Carvalho Aguiar, 255, São Paulo, Brazil. vitoryamaki@gmail.com.

|January 18, 2021

Summary

Meningioma mimics are common and can be misdiagnosed. Radiologists should watch for specific imaging red flags like bone erosion and unusual T2 signal to ensure correct diagnosis and treatment.

Keywords:

Hemangiopericytoma Lymphoma Meningioma Meningioma mimics Radiological findings Schwannoma

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Area of Science:

Neuroradiology
Neuro-oncology
Diagnostic Imaging

Background:

Meningiomas are common extra-axial intracranial tumors with typical imaging features.
However, a subset of lesions can mimic meningiomas on imaging, leading to diagnostic challenges.

Purpose of the Study:

To describe the radiological features of meningioma mimics.
To highlight key imaging red flags that suggest a differential diagnosis beyond meningioma.

Main Methods:

Analysis of 348 lesions initially diagnosed as meningiomas via CT and MRI.
Evaluation of specific imaging characteristics including bone erosion, T2WI signal, dural tail, leptomeningeal involvement, and contrast enhancement patterns.

Main Results:

Meningioma mimics were found in 7.2% of cases.
Five key imaging red flags were identified: bone erosion, dural displacement sign, marked T2 hypointensity, marked T2 hyperintensity, and absence of a dural tail.
Hemangiopericytomas, lymphomas, and schwannomas were the most common mimics.

Conclusions:

The prevalence of meningioma mimics is significant and warrants radiologist awareness.
Recognizing these imaging red flags is crucial for accurate diagnosis, as mimics have different prognoses and treatment strategies.