Division of Neurological Surgery, Universidade de Sao Paulo, Rua Dr Eneas de Carvalho Aguiar, 255, São Paulo, Brazil.
Division of Radiology, Universidade de Sao Paulo, São Paulo, Brazil.
Neuroradiology. 2021 Aug;63(8):1215-1225. doi: 10.1007/s00234-021-02632-y. Epub 2021 Jan 18.
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.
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.
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.
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.
脑膜瘤是最常见的颅内外轴位脑肿瘤，具有典型的影像学表现。约有 2%的病例，组织病理学报告显示为不同的肿瘤或非肿瘤性病变，这些病变可能与脑膜瘤非常相似。我们描述了脑膜瘤模拟物的影像学特征，突出了需要考虑鉴别诊断的影像学“警示标志”。
我们分析了 2000 年 12 月至 2014 年 9 月间经手术治疗或活检证实的 348 例脑膜瘤的影像学诊断。我们确定了不属于脑膜瘤典型表现但提示其他病变的影像学特征。评估了 CT 和 MRI 的以下影像学特征：（a）骨侵蚀；（b）T2WI 高信号；（c）T2WI 低信号；（d）骨质破坏；（e）硬膜尾征；（f）软脑膜累及；（g）对比增强模式；（h）硬膜移位征。
我们发现脑膜瘤模拟物的患病率相对较高（7.2%）。具有均匀对比增强的硬膜内病变（52%）很容易被误诊为脑膜瘤。大多数病变模拟凸面（37.5%）或镰旁（21.9%）脑膜瘤。我们确定了五个影像学“警示标志”，可以提醒放射科医生考虑脑膜瘤模拟物：（1）骨侵蚀（22.2%）；（2）硬膜移位征（36%）；（3）明显的 T2 低信号（32%）；（4）明显的 T2 高信号（12%）；（5）无硬膜尾征（48%）。在我们的系列中，最常见的模拟病变是血管外皮细胞瘤，其次是淋巴瘤和神经鞘瘤。
脑膜瘤模拟物的患病率不容忽视。由于存在广泛的不同病变，导致不同的预后和治疗策略，因此了解有助于鉴别诊断的主要影像学表现非常重要。
