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Meningioma, convexity, T2 hyperintense

CLINICAL HISTORY:
This 55-year old woman complains of many years of frontal headaches. Now the headaches have increased in intensity, with development of speech disturbances and difficulties in word finding. The patient is euphoric. She complains of dysequilibrium and decreased visual acuity.

NEUROLOGICAL EXAMINATION reveals gait instability with a tendency to fall to the right and a positive Romberg test to the right. There is right hemihypoesthesia, and speech disturbances.

CT:
a) NON-CONTRAST SCAN (IMAGE 1): There is profound midline shift to the right with compression and almost total obliteration of the right lateral ventricle. A hypodense mass (arrowheads) is seen in the right frontal region of, with broad implantation on the convexity.

b) CONTRAST-ENHANCED SCAN (IMAGE 2): There is intense and homogeneous enhancement of the lesion.

MRI:
a) TRANSAXIAL T2-WEIGHTED (2500/90/1) SPIN-ECHO SEQUENCE (IMAGE 3): Confirmation of the midline shift to the right and the compression of the left lateral ventricle. The lesion again is broadly implanted on the convexity. There is striking hyperintensity of the lesion. The inner border of the lesion is somewhat irregular.

b) CORONAL T1-WEIGHTED (600/20/1) SPIN-ECHO SEQUENCE (IMAGE 4): Again the lesion is broadly implanted on the convexity. The signal of the lesion is strongly hypointense. At the periphery of the lesion some signal drop-outs can be seen, probably representing draining veins. Notice the substantial displacement of the midline and the depression of the Sylvian fissure (arrowheads).

c) TRANSAXIAL (IMAGE 5) AND CORONAL (IMAGE 6) GADOLINIUM-ENHANCED SPIN-ECHO SEQUENCES: There is intense and very homogeneous contrast enhancement of the lesion. There is a dural tail (arrows) seen in all directions.

ANGIOGRAPHY: selective injection of the left internal maxillary artery (IMAGE 7): Marked hypervascularity of the tumor is noted, fed by the middle meningeal artery (arrowheads) and with a typical radial orientation of the tumor vessels.

RADIOLOGICAL DIAGNOSIS: is meningioma, based on the extraaxial location of the tumor, the broad implantation on the dura of the convexity, the homogeneous appearance, the intense enhancement and the dural tail.

SURGICAL FINDINGS: At surgery, the lesion was found with insertion on the dura mater over a distance of 9 cm. The tumor weighed 150 gr. The lesion was blue-purple, very soft and highly vascularised. Total resection was performed.

ANATOMOPATHOLOGY is a fibroblastic meningioma with myxomatous changes.

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Meningioma

 

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Fig. 1

Meningioma, convexity, T2 hyperintense, Fig. 1
Meningioma, convexity, T2 hyperintense, Fig. 2
Meningioma, convexity, T2 hyperintense, Fig. 3
Meningioma, convexity, T2 hyperintense, Fig. 4
Meningioma, convexity, T2 hyperintense, Fig. 5
Meningioma, convexity, T2 hyperintense, Fig. 6
Meningioma, convexity, T2 hyperintense, Fig. 7