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MRI in the diagnosis of cystic meningiomas: surgical implications
L Ferrante1, M Acqui, P Lunardi
1Department of Neurological Sciences, University of Rome La Sapienza, Italy.
Abstract:
Nine cases of cystic meningioma diagnosed by MRI are described. All cases were surgically confirmed. The lesion was extra-axial with a clear dural attachment. On T1-weighted images the solid component was iso-hypo-intense in 6 cases and iso-hyperintense in 3; on T2-weighted images it was hyperintense in 7 cases, iso-intense in 2. After i.v. injection of gadolinium, the solid component enhanced in all cases and a "dural tail" were visible in 8 cases. No gadolinium enhancement of the cyst wall was observed in Nauta's types II and III. The authors found MRI to be very useful for diagnosis of cystic meningioma but insufficient for differential diagnosis between types II and III according to Nauta. This aspect requires further study, especially in view of the implications of this differentiation in terms of surgical management.
Insights
Magnetic Resonance Imaging (MRI) aids in diagnosing cystic meningiomas, extra-axial tumors with dural attachment. While MRI is useful, differentiating specific subtypes requires further investigation for optimal surgical planning.
Area of Science:
- Neuroradiology
- Neurosurgery
- Oncology
Background:
- Cystic meningiomas are rare extra-axial tumors.
- Accurate preoperative diagnosis is crucial for surgical management.
Purpose of the Study:
- To evaluate the utility of Magnetic Resonance Imaging (MRI) in diagnosing cystic meningiomas.
- To assess MRI's capability in differentiating between Nauta's classification types of cystic meningiomas.
Main Methods:
- Retrospective review of nine surgically confirmed cystic meningioma cases.
- Analysis of MRI findings including T1-weighted, T2-weighted, and post-contrast gadolinium-enhanced sequences.
- Correlation of imaging features with surgical and histopathological findings.
Main Results:
- MRI demonstrated extra-axial lesions with dural attachment in all nine cases.
- The solid component showed variable signal intensity on T1 and T2 weighted images and consistent enhancement after gadolinium.
- A "dural tail" sign was observed in 8 out of 9 cases.
- No gadolinium enhancement of the cyst wall was noted in Nauta's types II and III.
Conclusions:
- MRI is a valuable tool for diagnosing cystic meningiomas.
- MRI is currently insufficient for differentiating between Nauta's types II and III cystic meningiomas.
- Further research is needed to improve differential diagnosis for tailored surgical approaches.