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Usefulness of a Rim-Enhancing Pattern on the Contrast-Enhanced 3D-FLAIR Sequence and MRI Characteristics for
T Panyaping1, M Punpichet1, P Tunlayadechanont1
1From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand.
Background And Purpose:
Meningiomas are the most common type of extra-axial dural-based tumors; however, malignant dural-based tumors can mimic meningiomas on imaging. The aim of this study was to determine the efficacy of differentiating meningiomas from malignant dural-based tumors by using rim-enhancement patterns on a contrast-enhanced FLAIR sequence and MR imaging characteristics.
Materials And Methods:
This retrospective study included 102 patients with meningiomas and 31 patients with malignant dural-based tumors who underwent pretreatment MR imaging. The rim-enhancement patterns on contrast-enhanced FLAIR and MR imaging characteristics, including the dural tail sign, hyperostosis, bony destruction, leptomeningeal enhancement, peritumoral edema, T2-weighted signal intensity, and tumor enhancement were evaluated.
Results:
Complete rim enhancement of the tumor-brain interface on contrast-enhanced FLAIR (contrast-enhanced-FLAIR rim sign) was present in most meningiomas (91/102, 89.2%) and at significantly greater frequency than in malignant dural-based tumors (2/31, 6.5%) (P < .001). Complete contrast-enhanced FLAIR rim enhancement provided high sensitivity (89.2%), specificity (93.5%), and accuracy (90.2%) for diagnosing meningioma. Additionally, hyperostosis was an MR imaging characteristic that suggested a diagnosis of meningioma. In contrast, bony destruction with cortical breakthrough and leptomeningeal enhancement suggested malignant dural-based tumors. There were limitations of meningiomas of <2.0 cm or at cavernous sinus locations that did not demonstrate contrast-enhanced FLAIR rim enhancement.
Conclusions:
The rim-enhancement pattern on contrast-enhanced FLAIR could help differentiate meningiomas and malignant dural-based tumors. The presence of complete rim enhancement on contrast-enhanced FLAIR was a robust predictive sign for meningioma.
Insights
Contrast-enhanced FLAIR imaging effectively differentiates meningiomas from malignant dural tumors. Complete rim enhancement on this sequence is a strong indicator for diagnosing meningioma, improving diagnostic accuracy.
Area of Science:
- Neuroradiology
- Oncology
- Medical Imaging
Background:
- Meningiomas are common extra-axial tumors that can be mistaken for malignant dural-based tumors on imaging.
- Accurate differentiation is crucial for appropriate patient management and treatment planning.
Purpose of the Study:
- To evaluate the effectiveness of contrast-enhanced FLAIR (CE-FLAIR) rim-enhancement patterns in distinguishing meningiomas from malignant dural-based tumors.
- To assess the diagnostic performance of CE-FLAIR rim sign and other MR imaging characteristics.
Main Methods:
- Retrospective analysis of 102 meningioma and 31 malignant dural-based tumor cases.
- Evaluation of CE-FLAIR rim-enhancement patterns and other MR imaging features like dural tail sign, hyperostosis, bony destruction, and leptomeningeal enhancement.
Main Results:
- Complete CE-FLAIR rim enhancement was significantly more frequent in meningiomas (89.2%) than malignant tumors (6.5%) (P < .001).
- CE-FLAIR rim enhancement demonstrated high sensitivity (89.2%), specificity (93.5%), and accuracy (90.2%) for meningioma diagnosis.
- Hyperostosis suggested meningioma, while bony destruction and leptomeningeal enhancement indicated malignant tumors.
Conclusions:
- The rim-enhancement pattern on CE-FLAIR MRI is a valuable tool for differentiating meningiomas from malignant dural-based tumors.
- Complete rim enhancement on CE-FLAIR is a robust predictive sign for meningioma.
