Transcranial ultrasonography imaging of a suprasellar meningioma: A case description and technical notes

Abstract

Background: Computed tomography (CT) and magnetic resonance (MR) represent the gold standard for evaluating intracranial tumours, such as meningiomas; most meningiomas can be managed by surveillance and clinical follow-up, therefore, the ideal technology should be cheap, non-invasive, safe and able to reduce radiation exposure. Transcranial colour-coded duplex sonography (TCCS) can detect space-occupying lesions, but its full potential for clinical practice is still unexpressed.

Aims and methods: We describe the ability of TCCS to directly and accurately image, in a 77-year-old woman hospitalised for septic shock and coma, a suprasellar meningioma with a spatial resolution very similar to CT.

Results: The meningioma was clearly visualised as a roundish mass, with well-defined borders, heterogeneously hyperechogenic compared with the surrounding brain structures; multiple intralesional calcifications were detectable as highly echogenic spots. Latero-lateral and antero-posterior diameters were well measurable.

Discussion: TCCS should not be considered as an alternative to CT and MR imaging, but it might have a complementary role, useful for use at the bedside in uncooperative or non-transportable patients and for follow-up, when an adequate acoustic window is guaranteed. Neurologists and neuroradiologists should further explore the full potential of this technology.

Keywords: Meningioma; neuroimaging; transcranial colour‐coded duplex sonography.

Figure 1

Non‐contrast‐enhanced CT shows a roundish, hyperdense, suprasellar mass with intralesional calcifications (AP × LL × CC diameters: 23 × 30 × 23 mm). The black arrow indicates the mass.

Figure 2

Transtemporal insonation window. The sonographic plane is usually skewed antero‐posteriorly by 10°–20° from anatomic axial plane by rotating transducer slightly toward occiput, and is also angled in frontal projection by 10°–20° from standard axial plane by tilting transducer caudally (back relative to front) by 10°–20°.

Figure 3

Transcranial sonography (transtemporal window) shows a roundish, well‐defined, suprasellar mass, heterogeneously hyperechogenic compared to surrounding brain structures, with multiple highly echogenic calcifications. Antero‐posterior and latero‐lateral diameters of meningioma measured (AP × LL diameters: 27 × 29 mm).

Figure 4

Transcranial colour‐coded duplex sonography shows normal circle of Willis. AcoP, right posterior communicating artery; LAA, left anterior cerebral artery; LMA, left middle cerebral artery; LPA, left posterior cerebral artery P1 segment; RAA, right anterior cerebral artery; RMA, right middle cerebral artery; RPA, right posterior cerebral artery P1 segment.