From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand.
From the Department of Diagnostic and Therapeutic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thialand
AJNR Am J Neuroradiol. 2023 Mar;44(3):247-253. doi: 10.3174/ajnr.A7780. Epub 2023 Feb 2.
Meningiomas are the most common type of extra-axial dural-based tumors; however, malignant dural-based tumors can mimic meningiomas on imaging. The aim of this study was to determine the efficacy of differentiating meningiomas from malignant dural-based tumors by using rim-enhancement patterns on a contrast-enhanced FLAIR sequence and MR imaging characteristics.
This retrospective study included 102 patients with meningiomas and 31 patients with malignant dural-based tumors who underwent pretreatment MR imaging. The rim-enhancement patterns on contrast-enhanced FLAIR and MR imaging characteristics, including the dural tail sign, hyperostosis, bony destruction, leptomeningeal enhancement, peritumoral edema, T2-weighted signal intensity, and tumor enhancement were evaluated.
Complete rim enhancement of the tumor-brain interface on contrast-enhanced FLAIR (contrast-enhanced-FLAIR rim sign) was present in most meningiomas (91/102, 89.2%) and at significantly greater frequency than in malignant dural-based tumors (2/31, 6.5%) ( < .001). Complete contrast-enhanced FLAIR rim enhancement provided high sensitivity (89.2%), specificity (93.5%), and accuracy (90.2%) for diagnosing meningioma. Additionally, hyperostosis was an MR imaging characteristic that suggested a diagnosis of meningioma. In contrast, bony destruction with cortical breakthrough and leptomeningeal enhancement suggested malignant dural-based tumors. There were limitations of meningiomas of <2.0 cm or at cavernous sinus locations that did not demonstrate contrast-enhanced FLAIR rim enhancement.
The rim-enhancement pattern on contrast-enhanced FLAIR could help differentiate meningiomas and malignant dural-based tumors. The presence of complete rim enhancement on contrast-enhanced FLAIR was a robust predictive sign for meningioma.
脑膜瘤是最常见的颅外硬脑膜基肿瘤类型；然而，恶性硬脑膜基肿瘤在影像学上可模拟脑膜瘤。本研究旨在通过使用对比增强 FLAIR 序列和磁共振成像特征的边缘增强模式来确定区分脑膜瘤和恶性硬脑膜基肿瘤的功效。
本回顾性研究纳入了 102 例脑膜瘤患者和 31 例恶性硬脑膜基肿瘤患者，所有患者均在术前接受了磁共振成像检查。评估了对比增强 FLAIR 上的边缘增强模式以及磁共振成像特征，包括脑膜尾征、骨质增生、骨破坏、软脑膜强化、瘤周水肿、T2 加权信号强度和肿瘤强化。
在大多数脑膜瘤（91/102，89.2%）中，肿瘤-脑界面的完全边缘增强（对比增强 FLAIR 边缘征象）比恶性硬脑膜基肿瘤（2/31，6.5%）更为常见（<0.001）。完全对比增强 FLAIR 边缘增强对诊断脑膜瘤具有较高的敏感性（89.2%）、特异性（93.5%）和准确性（90.2%）。此外，骨质增生是提示脑膜瘤的磁共振成像特征。相反，皮质突破和软脑膜强化的骨破坏提示恶性硬脑膜基肿瘤。脑膜瘤<2.0cm 或位于海绵窦位置时存在局限性，其不表现出对比增强 FLAIR 边缘增强。
对比增强 FLAIR 上的边缘增强模式有助于区分脑膜瘤和恶性硬脑膜基肿瘤。完全对比增强 FLAIR 边缘增强是脑膜瘤的一个强有力的预测征象。
