Skip to main content

Advertisement

SpringerLink
Log in

Dural-based lesions: is it a meningioma?

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  1. Bondy M, Ligon BL (1996) Epidemiology and etiology of intracranial meningiomas: a review. J Neurooncol 29:197–205. https://doi.org/10.1007/bf00165649

    Article  CAS  PubMed  Google Scholar 

  2. Ghosal N, Dadlani R, Gupta K, Furtado SV, Hegde AS (2012) A clinicopathological study of diagnostically challenging meningioma mimics. J Neurooncol 106:339–352. https://doi.org/10.1007/s11060-011-0669-3

    Article  PubMed  Google Scholar 

  3. Starr CJ, Cha S (2017) Meningioma mimics: five key imaging features to differentiate them from meningiomas. Clin Radiol 72:722–728. https://doi.org/10.1016/j.crad.2017.05.002

    Article  CAS  PubMed  Google Scholar 

  4. Watts J, Box G, Galvin A, Brotchie P, Trost N, Sutherland T (2014) Magnetic resonance imaging of meningiomas: a pictorial review. Insights Imaging 5:113–122. https://doi.org/10.1007/s13244-013-0302-4

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Johnson MD, Powell SZ, Boyer PJ, Weil RJ, Moots PL (2002) Dural lesions mimicking meningiomas. Hum Pathol 33:1211–1226. https://doi.org/10.1053/hupa.2002.129200

    Article  PubMed  Google Scholar 

  6. Smith AB, Horkanyne-Szakaly I, Schroeder JW, Rushing EJ (2014) From the radiologic pathology archives: mass lesions of the dura: beyond meningioma-radiologic-pathologic correlation. Radiographics 34:295–312. https://doi.org/10.1148/rg.342130075

    Article  PubMed  Google Scholar 

  7. Rogers L, Barani I, Chamberlain M, Kaley TJ, McDermott M, Raizer J, Schiff D, Weber DC, Wen PY, Vogelbaum MA (2015) Meningiomas: knowledge base, treatment outcomes, and uncertainties. A RANO review. J Neurosurg 122:4–23. https://doi.org/10.3171/2014.7.JNS131644

    Article  PubMed  PubMed Central  Google Scholar 

  8. Ginsberg LE (1996) Radiology of meningiomas. J Neurooncol 29:229–238

    Article  CAS  Google Scholar 

  9. Buetow MP, Buetow PC, Smirniotopoulos JG (1991) Typical, atypical, and misleading features in meningioma. Radiographics 11:1087–1106. https://doi.org/10.1148/radiographics.11.6.1749851

    Article  CAS  PubMed  Google Scholar 

  10. Ahn JY, Kwon SO, Shin MS, Kang SH, Kim YR (2002) Meningeal chloroma (granulocytic sarcoma) in acute lymphoblastic leukemia mimicking a falx meningioma. J Neurooncol 60:31–35. https://doi.org/10.1023/A:1020236031949

    Article  PubMed  Google Scholar 

  11. Siegelman ES, Mishkin MM, Taveras JM (1991) Past, present, and future of radiology of meningioma. Radiographics 11:899–910. https://doi.org/10.1148/radiographics.11.5.1947324

    Article  CAS  PubMed  Google Scholar 

  12. Paiva J, King J, Chandra R (2011) Extra-axial Hodgkin’s lymphoma with bony hyperostosis mimicking meningioma. J Clin Neurosci 18:725–727. https://doi.org/10.1016/j.jocn.2010.09.015

    Article  PubMed  Google Scholar 

  13. Lin C-K, Lai D-M (2013) IgG4-related intracranial hypertrophic pachymeningitis with skull hyperostosis: a case report. BMC Surg 13:37. https://doi.org/10.1186/1471-2482-13-37

    Article  PubMed  PubMed Central  Google Scholar 

  14. Smith AB, Horkanyne-Szakaly I, Schroeder JW, Rushing EJ (2014) From the radiologic pathology archives mass lesions of the dura: beyond menin-gioma-radiologic-pathologic correlation. Radiographics 34:295–312. https://doi.org/10.1148/rg.342130075

    Article  PubMed  Google Scholar 

  15. Nagar VA, Ye JR, Ng WH, Chan YH, Hui F, Lee CK, Lim CCT (2008) Diffusion-weighted MR imaging: diagnosing atypical or malignant meningiomas and detecting tumor dedifferentiation. Am J Neuroradiol 29:1147–1152. https://doi.org/10.3174/ajnr.A0996

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Lee IH, Kim ST, Kim HJ, Kim KH, Jeon P, Byun HS (2010) Analysis of perfusion weighted image of CNS lymphoma. Eur J Radiol 76:48–51. https://doi.org/10.1016/j.ejrad.2009.05.013

    Article  PubMed  Google Scholar 

  17. Zhang H, Rödiger LA, Shen T, Miao J, Oudkerk M (2008) Perfusion MR imaging for differentiation of benign and malignant meningiomas. Neuroradiology 50:525–530. https://doi.org/10.1007/s00234-008-0373-y

    Article  PubMed  PubMed Central  Google Scholar 

  18. Meyers SP, Hirsch WL, Curtin HD et al (1992) Chondrosarcomas of the skull base: MR imaging features. Radiology 184:103–108. https://doi.org/10.1148/radiology.184.1.1609064

    Article  CAS  PubMed  Google Scholar 

  19. Wilms G, Lammens M, Marchal G, Calenbergh FV, Plets C, Fraeyenhoven LV, Baert AL (1989) Thickening of dura surrounding meningiomas: MR features. J Comput Assist Tomogr 13:763–768. https://doi.org/10.1097/00004728-198909000-00003

    Article  CAS  PubMed  Google Scholar 

  20. Wilms G, Lammens M, Marchal G et al (1991) Prominent dural enhancement adjacent to nonmeningiomatous malignant lesions on contrast-enhanced MR images. Am J Neuroradiol 12:761–764

    CAS  PubMed  Google Scholar 

  21. Zhou J, Liu J, Zhang J, Zhang M (2012) Thirty-nine cases of intracranial hemangiopericytoma and anaplastic hemangiopericytoma: a retrospective review of MRI features and pathological findings. Eur J Radiol 81:3504–3510. https://doi.org/10.1016/j.ejrad.2012.04.034

    Article  PubMed  Google Scholar 

  22. Macagno N, Vogels R, Appay R, Colin C, Mokhtari K, French CNS SFT/HPC Consortium, Dutch CNS SFT/HPC Consortium, Küsters B, Wesseling P, Figarella-Branger D, Flucke U, Bouvier C (2019) Grading of meningeal solitary fibrous tumors/hemangiopericytomas: analysis of the prognostic value of the Marseille Grading System in a cohort of 132 patients. Brain Pathol 29:18–27. https://doi.org/10.1111/bpa.12613

    Article  CAS  PubMed  Google Scholar 

  23. Lyndon D, Lansley JA, Evanson J, Krishnan AS (2019) Dural masses: meningiomas and their mimics. Insights Imaging 10:11. https://doi.org/10.1186/s13244-019-0697-7

    Article  PubMed  PubMed Central  Google Scholar 

  24. Fountas KN, Kapsalaki E, Kassam M, Feltes CH, Dimopoulos VG, Robinson JS, Smith JR (2006) Management of intracranial meningeal hemangiopericytomas: outcome and experience. Neurosurg Rev 29:145–153. https://doi.org/10.1007/s10143-005-0001-9

    Article  CAS  PubMed  Google Scholar 

  25. Ma C, Xu F, Xiao YD et al (2014) Magnetic resonance imaging of intracranial hemangiopericytoma and correlation with pathological findings. Oncol Lett 8:2140–2144. https://doi.org/10.3892/ol.2014.2503

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Clarençon F, Bonneville F, Rousseau A, Galanaud D, Kujas M, Naggara O, Cornu P, Chiras J (2011) Intracranial solitary fibrous tumor: imaging findings. Eur J Radiol 80:387–394. https://doi.org/10.1016/j.ejrad.2010.02.016

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Neurological Surgery, Universidade de Sao Paulo, Rua Dr Eneas de Carvalho Aguiar, 255, São Paulo, Brazil

    Vitor Nagai Yamaki, Gustavo Correa Lordelo, Davi Jorge Fontoura Solla, Iuri Santana Neville, Manoel Jacobsen Teixeira & Wellingson Silva Paiva

  2. Division of Radiology, Universidade de Sao Paulo, São Paulo, Brazil

    Luis Filipe de Souza Godoy, Gabriela Alencar Bandeira & Leandro Tavares Lucato

  3. Instituto do Cancer do Estado de São Paulo – Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Iuri Santana Neville

Authors
  1. Vitor Nagai Yamaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Luis Filipe de Souza Godoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Gabriela Alencar Bandeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Leandro Tavares Lucato
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gustavo Correa Lordelo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Davi Jorge Fontoura Solla
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Iuri Santana Neville
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Manoel Jacobsen Teixeira
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Wellingson Silva Paiva
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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

Corresponding author

Correspondence to Vitor Nagai Yamaki.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in the studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00234-021-02632-y

Keywords

Search

Navigation