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Review
. 2016 Apr;27(2):145-54.
doi: 10.1016/j.nec.2015.11.007. Epub 2016 Feb 18.

Predicting Meningioma Consistency on Preoperative Neuroimaging Studies

Mark S Shiroishi  1 , Steven Y Cen  2 , Benita Tamrazi  3 , Francesco D'Amore  2 , Alexander Lerner  2 , Kevin S King  2 , Paul E Kim  2 , Meng Law  2 , Darryl H Hwang  2 , Orest B Boyko  2 , Chia-Shang J Liu  2
Affiliations
Review

Predicting Meningioma Consistency on Preoperative Neuroimaging Studies

Mark S Shiroishi et al. Neurosurg Clin N Am. 2016 Apr.

Abstract

This article provides an overview of the neuroimaging literature focused on preoperative prediction of meningioma consistency. A validated, noninvasive neuroimaging method to predict tumor consistency can provide valuable information regarding neurosurgical planning and patient counseling. Most of the neuroimaging literature indicates conventional MRI using T2-weighted imaging may be helpful to predict meningioma consistency; however, further rigorous validation is necessary. Much less is known about advanced MRI techniques, such as diffusion MRI, MR elastography (MRE), and MR spectroscopy. Of these methods, MRE and diffusion tensor imaging appear particularly promising.

Keywords: Consistency; Firmness; MRI; Meningioma; Minimally invasive neurosurgery; Neurosurgical planning; Prediction; Texture.

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Figures

Figure 1
Figure 1
Multiple meningiomas showing the spectrum of signal intensities on T2WI. Axial contrast-enhanced T1WI (A) demonstrates multiple small contrast-enhancing meningiomas. The corresponding axial T2WI (B) demonstrates that the 2 meningiomas along the anterior falx show hypointensity relative to gray matter (red arrows). The meningioma along the left frontal convexity appears isointense on T2WI (yellow arrow) while a small left parietal convexity parafalcine meningioma adjacent to the superior sagittal sinus appears hyperintense on T2WI (blue arrow).
Figure 2
Figure 2
Hyperintense meningioma on T2WI. Axial contrast-enhanced T1WI (A) demonstrates a homogeneously enhancing left fronto-temporal convexity meningioma. Axial T2WI (B) shows that the mass appears hyperintense compared to cortex.
Figure 3
Figure 3
Iso- to slightly hyperintense meningioma on T2WI. Axial contrast-enhanced T1WI (A) demonstrates a large homogeneously enhancing anterior skull-base meningioma. Axial T2WI (B) shows this mass appears iso- to slightly hyperintense compared to the cortex. The use of subjective visual criterial to classify signal intensity can be problematic in cases such as this.
Figure 4
Figure 4
Heterogeneous signal intensity on T2WI in a large meningioma. Axial contrast-enhanced T1WI (A) demonstrates a large heterogeneously enhancing right sphenoid-wing meningioma growing superiorly into the temporoinsular region along with mass effect and midline shift. Axial T2WI (B) demonstrates surrounding vasogenic edema and very heterogeneous signal intensity within the mass. Subjective categorization of signal intensity in the face of marked heterogeneity can be difficult.
See this image and copyright information in PMC

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