Intracranial hemangiopericytomas: MR and CT features
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Published on: July 5, 2021
M V Chiechi1, J G Smirniotopoulos, H Mena
1Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC, USA.
Purpose:
To describe the MR and CT imaging features of hemangiopericytoma and to identify the characteristics that might distinguish them from meningioma.
Methods:
We retrospectively reviewed the CT and MR findings in 34 pathologically proved cases of hemangiopericytoma. We evaluated the size, shape, and location of the tumor; the presence of hydrocephalus, edema, and mass effect; the type of dural attachment (broad-based or narrow-based) and bone changes (erosion, hyperostosis); and the tumor's density, signal, and contrast-enhancement characteristics.
Results:
Thirty of 34 tumors were 4 cm or more in greatest dimension, 32 were lobular, and only seven were in the posterior fossa. Hydrocephalus was present in 18, edema in 30, and mass effect in 33. Twenty-three had broad-based dural attachment and 11 had narrow-based attachment. All 26 unenhanced CT scans showed hyperdense tumors; 19 were heterogeneous and seven homogeneous. All 27 contrast-enhanced CT scans showed enhancement; 17 were heterogeneous and 10 homogeneous. Bone erosion was present in 17 of 29 hemangiopericytomas imaged with CT. None had hyperostosis or tumor calcifications. On T1-weighted MR images, 13 of 17 tumors were isointense with cortical gray matter; on T2-weighted image, 10 of 17 were isointense. All 14 tumors imaged with contrast enhanced T1-weighted MR imaging showed enhancement, and 13 of these were heterogeneous; eight of the 14 had a "dural tail" sign.
Conclusion:
Intracranial hemangiopericytomas are multilobulated, extraaxial tumors, sometimes associated with narrow-based dural attachment and bone erosion. Unlike with meningiomas, hyperostosis and intratumoral calcification are not present.
Insights
Intracranial hemangiopericytomas are extraaxial tumors often larger than 4 cm, frequently causing edema and mass effect. Imaging features like lobulated shape and bone erosion can help distinguish them from meningiomas, which lack hyperostosis and calcification.
Area of Science:
- Neuroradiology
- Oncology
- Pathology
Background:
- Hemangiopericytomas are rare, vascular tumors arising from pericytes.
- Distinguishing hemangiopericytomas from meningiomas is crucial for treatment planning.
- Advanced imaging techniques like MRI and CT are essential for characterizing intracranial tumors.
Purpose of the Study:
- To detail the computed tomography (CT) and magnetic resonance (MR) imaging characteristics of intracranial hemangiopericytomas.
- To identify imaging features that differentiate hemangiopericytomas from meningiomas.
Main Methods:
- Retrospective review of CT and MR findings in 34 pathologically confirmed hemangiopericytoma cases.
- Analysis of tumor size, shape, location, associated findings (hydrocephalus, edema, mass effect), dural attachment, bone changes, and enhancement patterns.
Main Results:
- Most tumors were large (≥4 cm), multilobulated, and frequently associated with edema and mass effect.
- Common findings included broad-based dural attachment, bone erosion on CT, and heterogeneous enhancement on both CT and MR.
- The "dural tail" sign was observed in some cases on contrast-enhanced T1-weighted MR imaging.
Conclusions:
- Intracranial hemangiopericytomas are typically large, multilobulated, extraaxial tumors.
- Imaging features such as bone erosion and absence of hyperostosis or calcification are key differentiating factors from meningiomas.