Department of Radiology, First Affiliated Hospital, Shantou University Medical College, Shantou, Guangdong, P.R.China.
Department of Radiology, Meizhou People's Hospital, Meizhou, Guangdong, P.R.China.
World Neurosurg. 2022 Jun;162:e605-e615. doi: 10.1016/j.wneu.2022.03.080. Epub 2022 Mar 23.
This study aimed to elucidate the clinicoradiologic features of spontaneous hemorrhagic meningiomas (HMs) and examine risk factors associated with meningioma hemorrhage.
We retrospectively reviewed 651 consecutive meningioma patients who underwent surgical resection in our hospital between January 2011 and January 2021. After exclusions, 169 patients were included for analysis. Patients were grouped according to presence of hemorrhage in the meningioma: the HM group (n = 19) and non-HM group (n = 150). Clinicoradiologic patient data were examined and compared using univariate and multivariate analysis.
HMs accounted for 2.9% of the entire series of meningiomas. HMs were mainly located at the convexity (63.2%). Mean diameter of HMs was 4.8 cm. On computed tomography, most HMs appeared as mixed isodensity and hyperdensity (84.2%). On magnetic resonance imaging, most appeared as mixed isointensity and hyperintensity on T1-weighted imaging and mixed hypointesity and hyperintensity on T2-weighted imaging (52.6%). Seventeen tumors exhibited heterogeneous enhancement, a dural tail, and peritumoral brain edema. Thirteen showed intratumoral cystic change. The misdiagnosis rate was significantly higher in HMs than non-HMs (31.6% vs. 7.3%; P = 0.005). Intratumoral cystic change was the only independent predictor of meningioma hemorrhage in multivariate analysis (odds ratio 4.116; 95% confidence interval 1.138-14.894; P = 0.031).
Mixed isodensity/intensity and hyperdensity/intensity on computed tomography/magnetic resonance imaging in conjunction with heterogenous enhancement, a dural tail, and varying degrees of peritumoral brain edema suggest a high possibility of HM. Presence of intratumoral cystic change was an independent risk factor associated with meningioma hemorrhage.
本研究旨在阐明自发性出血性脑膜瘤（HM）的临床影像学特征，并探讨与脑膜瘤出血相关的危险因素。
我们回顾性分析了 2011 年 1 月至 2021 年 1 月期间在我院接受手术切除的 651 例连续脑膜瘤患者，排除后纳入 169 例患者进行分析。根据脑膜瘤是否存在出血将患者分为 HM 组（n=19）和非 HM 组（n=150）。使用单因素和多因素分析检查并比较临床影像学患者数据。
HM 占整个脑膜瘤系列的 2.9%。HM 主要位于凸面（63.2%）。HM 的平均直径为 4.8cm。在 CT 上，大多数 HM 表现为混合等密度和高密度（84.2%）。在 MRI 上，大多数 HM 在 T1 加权成像上表现为混合等强度和高强度，在 T2 加权成像上表现为混合低强度和高强度（52.6%）。17 个肿瘤表现为不均匀增强、硬膜尾征和瘤周脑水肿。13 个表现为肿瘤内囊性变。HM 的误诊率明显高于非 HM（31.6%比 7.3%；P=0.005）。多因素分析显示，肿瘤内囊性变是脑膜瘤出血的唯一独立预测因素（比值比 4.116；95%置信区间 1.138-14.894；P=0.031）。
CT/MRI 上混合等密度/强度和高密度/强度，伴不均匀增强、硬膜尾征和不同程度的瘤周脑水肿提示 HM 可能性高。肿瘤内囊性变是与脑膜瘤出血相关的独立危险因素。
