Abstract
Purpose
Meningiomas are the most common extra-axial intracranial neoplasms with typical radiological findings. In approximately 2% of cases, histopathological reports reveal different neoplasms or non-neoplastic lesions that can closely mimic meningiomas. We describe radiological features of meningioma mimics highlighting imaging red flags to consider a differential diagnosis.
Methods
A total of 348 lesions with radiological diagnosis of meningiomas which underwent to surgical treatment or biopsy between December of 2000 and September of 2014 were analyzed. We determined imaging features that are not a typical finding of meningiomas, suggesting other lesions. The following imaging characteristics were evaluated on CT and MRI: (a) bone erosion; (b) hyperintensity on T2WI; (c) hypointensity on T2WI; (d) bone destruction; (e) dural tail; (f) leptomeningeal involvement; (g) pattern of contrast enhancement; (h) dural displacement sign.
Results
We have a relatively high prevalence of meningioma mimics (7.2%). Dural-based lesions with homogeneous contrast enhancement (52%) are easily misdiagnosed as meningiomas. Most lesions mimic convexity (37.5%) or parafalcine (21.9%) meningiomas. We have determined five imaging red flags that can alert radiologists to consider meningioma mimics: (1) bone erosion (22.2%); (2) dural displacement sign (36%); (3) marked T2 hypointensity (32%); (4) marked T2 hyperintensity (12%); (5) absence of dural tail (48%). The most common mimic lesion in our series was hemangiopericytomas, followed by lymphomas and schwannomas.
Conclusion
The prevalence of meningioma mimics is not negligible. It is important to have awareness on main radiological findings suggestive of differential diagnosis due to a wide range of differentials which lead to different prognosis and treatment strategies.
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V.N.Y., G.A.B., L. F. S. G., L.T.L, I.S.N. and W.S.P. contributed to design and implementation of the research;
V.N.Y., G.C.L. and D.J.F.S. contributed to retrospective review of data, statistical analysis and reported results;
G.A.B., L. F. S. G. and L.T.L reviewed neuroimages and confirmed radiological signs reported on results;
V.N.Y. and L. F. S. G. wrote the paper;
W.S.P. and M.J.T. supervised the project;
All the authors critically reviewed the manuscript before submission
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Nagai Yamaki, V., de Souza Godoy, L.F., Alencar Bandeira, G. et al. Dural-based lesions: is it a meningioma?. Neuroradiology 63, 1215–1225 (2021). https://doi.org/10.1007/s00234-021-02632-y
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DOI: https://doi.org/10.1007/s00234-021-02632-y