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Gadolinium 3D MRA, intracranial pathology, case 4

Meningioma of the skull base.

Clinical history
An extensive meningioma of the skull base was diagnosed in this 50-year-old-female, 25 years ago. Only partial removal of the tumor could be achieved at the time of diagnosis and the patient benefits from yearly MRI control examinations since 1985. Clinical history mentions chronic headaches and difficulties with swallowing as well as speech problems.
Neurological examination shows paralysis of the left lower cranial nerves including the V to the XIIth nerve.
More recently the patient suffered from nausea, vomiting and vertiginous sensations. As this huge tumor involved the left carotid as well as the vertebral and basilar arteries, an MRA study is added to the standard MRI study.

Image 1
Axial T2WI show the large hypo-intense lesion mostly calcified with an intracranial component deforming the medulla and pons. On the other hand, a huge extra-cranial component is also seen including totally the left carotid artery (arrow).

Image 2
Axial T1WI at the same level as the T2WI shown before.

Image 3
Axial high resolution Proton Density images used for the orientation of MRA acquisitions.

Image 4
Sagittal T1W images. On slice A, the left carotid artery is well seen and is entirely surrounded by the cervical extension of the tumor.

Images 5 - 6 - 7
MIP images obtained from the 3DTOF set of acquisition. Displacement of the left vertebral artery is shown (image 5 - black arrow). There is a focal narrowing of the left carotid artery in its upper cervical segment immediately before entering the petrous carotid canal (image 7 - arrowhead).

Images 8 - 9
MIP images obtained with the "arterial" acquisitions.
The precise displacement of the left vertebral artery is better shown on the those MRA images. Moreover, the stenosis of the left internal carotid seems here more limited compared to what is seen on the TOF images.

Images 10 - 11
On these images, the left carotid artery stenosis looks again more extensive than what is observed with Gd 3D MRA techniques. In fact, due to turbulences at the site of stenosis MR signal is fading on TOF and PCA acquisition. In this case, Gd 3D MRA images were definitely superior in depicting in an optimal way the stenosis when compared to the standard digital angiograms obtained subsequently. For the follow-up examination we recommended to apply only the bolus angiography technique.

Search also:
- Gd 3D MRA: intracranial pathology

 

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Fig. 1

Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 1
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 2
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 3
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 4
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 5
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 6
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 7
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 8
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 9
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 10
Gadolinium 3D MRA, intracranial pathology, case 4, Fig. 11