, Volume 32, Issue 2, pp 94–97 | Cite as

Computed tomography and angiography do not reliably discriminate malignant meningiomas from benign ones

  • A. Servo
  • M. Porras
  • J. Jääskeläinen
  • A. Paetau
  • M. Haltia


Histological anaplasia, found in up to 10% of meningiomas, is an important prognostic sign as it is associated with increased recurrence rate and volume growth rate. We studied in retrospect a series of 230 primary intracranial meningiomas to discover whether histological anaplasia can be reliably foreseen in CT scans and angiograms. 205 meningiomas were histologically benign, and 25 meningiomas were classified as malignant (atypical or anaplastic), with either incipient (20) or overt (5) signs of anaplasia. Often CT parameters tested, three were associated significantly more often with malignant meningiomas: nodular contour (58.3% vs 26.7%), cysts (20.0% vs 4.4%) and absence of calcifications (92% vs 65.3%); none of these parameters was an absolute sign of anaplasia. ‘Mushrooming’, previously regarded as a definite sign of malignancy, was seen in 9% of benign meningiomas and in 21% of malignant ones. In angiography, no apparent differences between benign and malignant meningiomas were seen. The conclusion is that it is not possible to distinguish malignant meningiomas from benign ones with CT or angiography.

Key words

Brain tumours Meningioma Carotid angiography Computed tomography 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Jellinger K, Slowik F (1975) Histological subtypes and prognostic problems in meningiomas. J Neurol 208:279–298Google Scholar
  2. 2.
    MacCarty CS, Taylor WF (1979) Intracranial meningiomas: Experiences at the Mayo Clinic. Neurol Med Chir 19:596–574Google Scholar
  3. 3.
    Jääskeläinen J (1986) Seemingly complete removal of histologically benign intracranial meningioma: late recurrence rate and factors predicting recurrence in 657 patients. A multivariate analysis. Surg Neurol 26:461–469Google Scholar
  4. 4.
    Jääskeläinen J, Haltia M, Servo A (1986) Atypical and anaplastic meningiomas: radiology, surgery, radiotherapy, and outcome. Surg Neurol 25:233–242Google Scholar
  5. 5.
    Thomas HG, Dolman CL, Berry K (1981) Malignant meningiomas: clinical and pathological features. J Neurosurg 55:929–934Google Scholar
  6. 6.
    Jääskeläinen J, Haltia M, Laasonen E, Wahlström T, Valtonen S (1985) The growth rate of intracranial meningiomas and its relation to histology. An analysis of 43 patients. Surg Neurol 24:165–172Google Scholar
  7. 7.
    Vassiloutis J, Ambrose J (1979) Computerized tomography scanning appearances of intracranial meningiomas. J Neurosurg 50:320–327Google Scholar
  8. 8.
    Dieteman JL, Heldt N, Burquet JL, Medjek L, Maidrot D, Wackenheim A (1982) CT findings in malignant meningiomas. Neuroradiology 23:207–209Google Scholar
  9. 9.
    New PFJ, Aronow S, Hesselink JR (1980) National Cancer Institute Study: Evaluation of CT in the Diagnosis of intracranial neoplasms. Meningiomas. Radiology 136:665–675Google Scholar
  10. 10.
    Alvarez F, Roda JM, Romero MP, Morales C, Sarmiento MA, Blazquez MG (1987) Malignant and atypical meningiomas: A reappraisal of clinical, histological, and computed tomographic features. Neurosurgery 20:688–694Google Scholar
  11. 11.
    Jääskeläinen J, Servo A, Haltia M, Wahlström T, Valtonen S (1985) Intracranial haemangiopericytoma: radiology, surgery, radiotherapy and outcome in 21 patients. Surg Neurol 23:227–236Google Scholar
  12. 12.
    Russel DS, Rubinstein LJ (1989) Pathology of the tumours of the nervous system, 5th edn. Edward Arnold, London, pp 474–479Google Scholar
  13. 13.
    Goellner JR, Laws ER, Soule EH, Okazaki H (1987) Heamangiopericytoma of the meninges. Mayo Clinic experience. Am J Clin Pathol 70:375–380Google Scholar
  14. 14.
    Takase M, Takei Y (1982) On the true nature of so-called ‘angioblastic meningiomas’. Histopathological re-evaluation. Neurol Med Chir 22:901–909Google Scholar
  15. 15.
    New PJF, Hesselink JR, O'Carroll CP, Kleinman GM (1982) Malignant meningiomas: CT and histological criteria, including a new CT sign. AJNR 3:267–276Google Scholar
  16. 16.
    Burrows EH, Leeds NE (1981) Neuroradiology, vol 1. Churchill Livingstone. New York, pp 274–275Google Scholar
  17. 17.
    Taveras JM, Wood EH (1976) Diagnostic neuroradiology, vol 2. Williams & Wilkins, Baltimore, pp 751–759Google Scholar
  18. 18.
    Servo A, Jääskeläinen J, Wahlström T, Haltia M (1985) Diagnosis of intracranial haemangiopericytomas with angiography and CT scanning. Neuroradiology 27:38–43Google Scholar
  19. 19.
    Steinhoff H, Lanksch W, Kazner E, Grumme T (1977) Computed tomography in the diagnosis and differential diagnosis of glioblastomas. A quantitative study of 295 cases. Neuroradiology 14:193–200Google Scholar
  20. 20.
    Russell EJ, Ajax EG, Kricheff H, Budzilovich G (1980) Atypical computed tomographic features of intracranial meningiomas. Radiology 135:673–682Google Scholar
  21. 21.
    Kim KS, Rogers LF, Goldblatt D (1987) CT features of hyperostosing meningioma en plaque. AJNR 8:853–860Google Scholar
  22. 22.
    Shapir J, Coblentz C, Malanson D, Ethier R, Robitaille Y (1985) New CT finding in aggressive meningioma. AJNR 6:101–102Google Scholar
  23. 23.
    Smith HP, Cahha VR, Moody DM, Kelly DL Jr (1981) Biological features of meningiomas that determine the production of cerebral edema. Neurosurgery 8:428–433Google Scholar
  24. 24.
    Stevens JM, Ruiz JS, Kendall BE (1983) Observations on peritumoral oedema in meningioma, part 2. Mechanisms of oedema production. Neuroradiology 25:125–131Google Scholar
  25. 25.
    Lee KF, Lin S, Whiteley WH (1976) Angiographic findings in recurrent meningioma. Radiology 119:131–139Google Scholar
  26. 26.
    Elster AD, Challa VR, Gilbert TH, Richardson DN, Contento JC (1989) Meningiomas: MR and histopathologic features. Radiology 170:857–862Google Scholar
  27. 27.
    Cho KG, Hoshino T, Nagashima T, Murovic JA, Wilson CB (1986) Prediction of tumor doubling time in recurrent meningiomas. Cell kinetics studies with bromodeoxyuridine labeling. J Neurosurg 65:790–794Google Scholar
  28. 28.
    Siegers HP, Zuber P, Hamou M-F, Melle GD van, Tribolet N de (1989) The implications of heterogenous distribution of Ki-67 labelled cells in meningiomas. Br J Neurosurgery 3:101–108Google Scholar
  29. 29.
    Chiro G di, Hatazawa J, Katz DA, Rizzoli HV, Michele DJ de (1987) Glucose utilization by intracranial meningiomas as an index of tumor aggressivity and probablility of reccurence: A PET study. Radiology 164:521–526Google Scholar

Copyright information

© Springer-Verlag 1990

Authors and Affiliations

  • A. Servo
    • 1
    • 4
  • M. Porras
    • 1
  • J. Jääskeläinen
    • 2
  • A. Paetau
    • 3
  • M. Haltia
    • 3
  1. 1.Roentgen DivisionHelsinki University Central HospitalHelsinkiFinland
  2. 2.Department of NeurosurgeryHelsinki University Central HospitalHelsinkiFinland
  3. 3.Department of PathologyUniversity of HelsinkiHelsinkiFinland
  4. 4.Röntgen DivisionTöölö HospitalHelsinkiFinland

Personalised recommendations