Meningiomas with conventional MRI findings resembling intraaxial tumors: can perfusion-weighted MRI be helpful in differentiation?
BACKGROUND
To investigate the contribution of perfusion-weighted MRI to the differentiation of meningiomas with atypical conventional MRI findings from intraaxial tumors.


METHODS
We retrospectively analyzed 54 meningiomas, 12 glioblastomas and 13 solitary metastases. We detected 6 meningiomas with atypical features on conventional MRI resembling intraaxial tumors. The regional cerebral blood flow (rCBV) ratios of all tumors were calculated via perfusion-weighted MRI. The signal intensity-time curves were plotted and three different curve patterns were observed. The type 1 curve resembled normal brain parenchyma or the postenhancement part was minimally below the baseline, the type 2 curve was similar to the type 1 curve but with the postenhancement part above the baseline, and the type 3 curve had the postenhancement part below the baseline accompanied by widening of the curve. Student's t-test was used for statistical analysis.


RESULTS
On CBV images meningiomas were hypervascular and the mean rCBV ratio was 10.58+/-2.00. For glioblastomas and metastatic lesions, the rCBV ratios were 5.02+/-1.40 and 4.68+/-1.54, respectively. There was a statistically significant difference in rCBV ratios between meningiomas and glioblastomas and metastases (P<0.001). Only one of the meningiomas displayed a type 2 curve while five showed a type 3 curve. Glioblastomas and metastases displayed either a type 1 or a type 2 curve. None of the meningiomas showed a type 1 curve and none of the glioblastomas or metastases showed a type 3 curve.


CONCLUSIONS
Differentiating meningiomas with atypical conventional MRI findings from malignant intraaxial tumors can be difficult. Calculation of rCBV ratios and construction of signal intensity-time curves may contribute to the differentiation of meningiomas from intraaxial tumors.
Hakyemez
Bahattin
B
Department of Radiology, Uludag University Medical School, Bursa, Turkey. bahattinh@hotmail.com
Yildirim
Nalan
N
Erdoğan
Cüneyt
C
Kocaeli
Hasan
H
Korfali
Ender
E
Parlak
Mufit
M
D000368:Aged; D001932:Brain Neoplasms / Q000175:diagnosis* / Q000503:physiopathology / Q000556:secondary; D002560:Cerebrovascular Circulation / Q000502:physiology; D003937:Diagnosis, Differential; D005260:Female; D005909:Glioblastoma / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis* / Q000503:physiopathology; D008579:Meningioma / Q000175:diagnosis* / Q000503:physiopathology; D008875:Middle Aged; D012189:Retrospective Studies