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Presentation1.pptx, supratentorial brain tumour
Meningiomas account for 15% of all intracranial tumors and originate from the dura or arachnoid membranes. They are most common in middle-aged adults and affect women twice as often as men. Meningiomas are typically benign, slow-growing tumors that indent the brain as they enlarge. On CT imaging, meningiomas appear well-circumscribed, homogeneous, and hyperdense, and may induce hyperostosis of adjacent bone. MRI often reveals a characteristic "dural tail" sign of enhancement. Other histologic variants include hemangiopericytomas, which have a narrow dural attachment and lobulated shape.
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Presentation1.pptx, supratentorial brain tumour
- 5. Extra-axial Neoplasms Meningiomas accountfor 15% of all intracranial tumors and are the most common extra-axial tumor. They originate from the dura or arachnoid and occur in middle-aged adults. Women are affected twice as often as men. Meningiomas are well-differentiated, benign, and encapsulated lesions that indent the brain as they enlarge. They grow slowly and may be present for many years before producing symptoms. The histologic picture shows cells of uniform size that tend to form whorls or psammoma bodies. The parasagittal region is the most frequent site for meningiomas, followed by the sphenoid wings, parasellar region, olfactory groove, cerebello-pontine angle, and rarely the intraventricular region. Meningiomas often induce an osteoblastic reaction in the adjacent bone, resulting in a characteristic focal hyperostosis. They are also hypervascular, receiving their blood supply predominantly from dural vessels.
- 7. Meningioma: CT Imaging Non-Contrast – Sharply Circumscribed – Homogeneous – Hyperdense (+/- Ca++) NOT from psammoma bodies ! – Broad Dural Surface – Bone Changes (Hyperostosis) Enhanced CT – Homogeneous Enhancement Meningioma: Vasogenic Edema VASCULAR – parasitization of MCA, etc. – compression of cortical aa./vv. COMPRESSIVE TRAUMA SECRETORY EFFECT “TRANSCORTICAL FLOW” – Close apposition of tumor to brain – Thinned cortex – +/- infiltration of brain – Fluid gradient from meningioma into brain
- 8. Dural Tail Curvilinear enhancement “dural flair” First reported w/meningioma First reported to be neoplastic invasion What is it REALLY? – Thickening of the dura – Vasocongestion of the dura – Edema of the dura Prevalence of "dural tail sign" Rokni-Yazdi H, Sotoudeh H. Eur J Radiol. 2006 Oct;60(1):42-5. 22/98 patients (22.44%) of intracranial masses had "dural tail sign“ – 18 meningiomas – 2 pituitary adenomas – 1 primary cerebral lymphoma The "dural tail sign" had a sensitivity of 58.6% and specificity of 94.02% in diagnosis of meningioma.
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- 24. Hemangiopericytoma Syn: “angioblastic meningioma” Cell of Origin – perivascular pericyte of Zahn and/or Zimmerman WHO 2-3 < 1% of primary CNS M 1.4:1 F Age – 40’s Dural based, bone destruction, lobulated HEMANGIOPERICYTOMA (HPC) Narrow dural base (“Mushrooming”) No Hyperostosis No Calcification in tumor Lobulated (not hemispheric) Internal Signal Voids (on MRI) – irregular and multiple Hypervascular on Angio – irregular patterns
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