The tentorium in axial section. II. Lesion localization

Area of Science:

• Neuroradiology
• Medical Imaging
• Neuroanatomy

Background:

• Accurate localization of juxtatentorial lesions is crucial for diagnosis and treatment planning.
• Conventional imaging techniques may present challenges in precisely differentiating lesion locations within the posterior fossa and supratentorial compartments.

Purpose of the Study:

• To evaluate the efficacy of contrast-enhanced axial computed tomography (CT) scans utilizing opacified tentorial bands for precise localization of juxtatentorial lesions.
• To determine the utility of tentorial band morphology in distinguishing supratentorial from infratentorial lesions and assessing meningioma extension.

Main Methods:

• Retrospective analysis of contrast-enhanced axial CT scans in patients with juxtatentorial lesions.
• Detailed assessment of lesion position relative to the V-shaped tentorial bands.
• Evaluation of the tentorial border's contour (flattening) for location identification.
• Specific focus on identifying transincisural extension of meningiomas.

Main Results:

• Opacified tentorial bands on contrast-enhanced axial CT scans allow for accurate localization of most juxtatentorial lesions.
• Lesions lateral to diverging bands are supratentorial; medial lesions are infratentorial and/or incisural.
• Flattening of the tentorial border aids in lesion localization.
• The method reliably identifies transincisural meningioma extension but has limitations in differentiating true transtentorial growth from upward tentorial bulging.

Conclusions:

• Contrast-enhanced CT with opacified tentorial bands is a valuable tool for localizing juxtatentorial lesions.
• This technique enhances diagnostic accuracy for infratentorial and supratentorial lesion differentiation.
• While effective for meningioma extension, careful interpretation is needed for complex transtentorial growths.