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Modeling Brain Metastases Through Intracranial Injection and Magnetic Resonance Imaging
Published on: June 7, 2020
Metastatic Meningioma: Neuroradiologic and Molecular Imaging Perspectives
Pranjal Rai1,2, Tej Mehta3, Shweta S Kumar4
1Department of Radiology, Tata Memorial Hospital, Mumbai, India.
Abstract:
Meningiomas are the most common primary central nervous system tumors, arising from arachnoid cap cells and typically following a benign clinical course. However, a minority of cases-particularly higher-grade meningiomas-exhibit aggressive behavior, including local invasion, recurrence, and, in rare instances, extracranial metastasis. Metastatic meningioma, defined as dissemination beyond the cranial and spinal compartments, remains exceptionally uncommon, with reported incidence ranging from 0.1% to 0.76%. Common metastatic sites include the lungs, bone, liver, and lymph nodes, although virtually any organ may be involved. Proposed mechanisms of spread include hematogenous dissemination via venous sinuses, cerebrospinal fluid seeding in high-grade variants, and possibly lymphatic dissemination. Imaging features that suggest metastatic potential include irregular margins, heterogeneous enhancement, prominent peritumoral edema, and bone destruction. Advanced modalities, such as gallium 68 DOTA-Tyr3-octreotide PET/CT and fluorine 18 fluorodeoxyglucose PET, play an increasing role in detecting and characterizing both known and occult metastatic lesions. Molecular alterations, including TERT promoter mutations, CDKN2A/B deletions, and somatostatin receptor 2 overexpression, are increasingly recognized as important markers for risk stratification and targeted therapy selection. Management requires a multimodal approach, including surgery, radiation therapy, and emerging systemic options such as peptide receptor radionuclide therapy and immune checkpoint inhibitors. Given the rarity and clinical complexity of this entity, radiologists must maintain a high index of suspicion, particularly while evaluating in high-grade or recurrent meningiomas. Keywords: Meninges, Brain/Brain Stem, Neuro-oncology, Molecular Imaging, Metastatic Meningioma, DOTATATE, High-Grade Meningioma, Somatostatin Receptor Imaging, SSTR, Peptide Receptor Radionuclide Therapy © RSNA, 2025.
Insights
Metastatic meningioma, a rare complication of brain tumors, can spread to distant organs. Early detection and multimodal treatment are crucial for managing this aggressive condition.
Area of Science:
- Neuro-oncology
- Radiology
- Molecular Pathology
Background:
- Meningiomas are common primary central nervous system tumors.
- Higher-grade meningiomas can exhibit aggressive behavior, including metastasis.
- Metastatic meningioma is rare, with incidence between 0.1% and 0.76%.
Purpose of the Study:
- To review the incidence, mechanisms, imaging features, and management of metastatic meningioma.
- To highlight the role of advanced imaging and molecular markers in risk stratification and therapy selection.
Main Methods:
- Review of literature on metastatic meningioma.
- Discussion of imaging modalities including PET/CT.
- Analysis of molecular alterations and treatment strategies.
Main Results:
- Common metastatic sites include lungs, bone, and liver.
- Imaging findings suggesting metastatic potential include irregular margins and bone destruction.
- Molecular markers like TERT promoter mutations are associated with aggressive disease.
Conclusions:
- Metastatic meningioma requires a high index of suspicion in high-grade or recurrent cases.
- Multimodal management involving surgery, radiation, and systemic therapies is essential.
- Advanced imaging and molecular profiling aid in diagnosis and treatment planning.
