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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.
Purpose:
Meningiomas are the most common extra-axial intracranial neoplasms with typical radiological findings. In approximately 2% of cases, histopathological reports reveal different neoplasms or non-neoplastic lesions that can closely mimic meningiomas. We describe radiological features of meningioma mimics highlighting imaging red flags to consider a differential diagnosis.
Methods:
A total of 348 lesions with radiological diagnosis of meningiomas which underwent to surgical treatment or biopsy between December of 2000 and September of 2014 were analyzed. We determined imaging features that are not a typical finding of meningiomas, suggesting other lesions. The following imaging characteristics were evaluated on CT and MRI: (a) bone erosion; (b) hyperintensity on T2WI; (c) hypointensity on T2WI; (d) bone destruction; (e) dural tail; (f) leptomeningeal involvement; (g) pattern of contrast enhancement; (h) dural displacement sign.
Results:
We have a relatively high prevalence of meningioma mimics (7.2%). Dural-based lesions with homogeneous contrast enhancement (52%) are easily misdiagnosed as meningiomas. Most lesions mimic convexity (37.5%) or parafalcine (21.9%) meningiomas. We have determined five imaging red flags that can alert radiologists to consider meningioma mimics: (1) bone erosion (22.2%); (2) dural displacement sign (36%); (3) marked T2 hypointensity (32%); (4) marked T2 hyperintensity (12%); (5) absence of dural tail (48%). The most common mimic lesion in our series was hemangiopericytomas, followed by lymphomas and schwannomas.
Conclusion:
The prevalence of meningioma mimics is not negligible. It is important to have awareness on main radiological findings suggestive of differential diagnosis due to a wide range of differentials which lead to different prognosis and treatment strategies.
Insights
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.
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.
