Answer for BIR CoW 05 Jan 2025
PARASELLAR MENINGIOMA
Findings
T1 isointense, T2 hyperintense lesion involving right parasellar region with sellar extension and causing compression and displacement of pituitary gland.It is noted extending into right cavernous sinus, right superior orbital fissure, completely encasing and narrowing the cavernous segment of right internal carotid artery. on contrast administration, the lesion shows avid homogenous enhancement with adjacent dural enhancement associated with thickening reflecting dural tail sign.
Discussion
Meningiomas are the most common benign intracranial tumor. They originate from arachnoid cap cells. Although the majority of meningiomas are benign, these tumors can grow slowly until they are very large if left undiscovered, and, in some locations, can be severely disabling and life-threatening. Common locations of meningiomas: Convexity meningioma 20% Parasagittal/falcine meningioma 25% Sphenoid wing 20% Olfactory groove 10% Suprasellar/Parasellar 10% Posterior fossa/ cerebello-pontine angle meningioma 10% Intraventricular 2% Intraorbital < 2% Tentorial < 2% Foramen magnum meningioma < 2% Morphological types of meningiomas: 1.globose = globular, well-demarcated neoplasm, with wide dural attachment 2.en plaque = sheet-like extension covering dura without parenchymal invagination 3.intraosseous meningioma = a subtype of primary extradural meningiomas 4.intraventricular 5.Lipomatous CT and MRI semiology of meningiomas CT: Meningioma is a well-defined broad-based extra-axial mass, hyperdense on NECT, with homogeneous enhancement, and frequent calcifications that are seen on CT (25%). Also bone erosion or hyperostosis can be associated with meningiomas and is well appreciated on CT MRI: On T1 Wi meningiomas are generally isointense to gray matter, iso-/ or hyperintense to gray matter on T2 Wi and demonstrate intense enhancement on T1 Wi. A focal thickened collar of enhancement can often be found adjacent to the tumor's dural attachment. This is the "dural tail" sign which histologically can be associated with tumor infiltration or merely inflamation. Dural tail sign” (DTS), “dural thickening”, “meningeal sign” are similar terms describing thickening of the dura adjacent to an intracranial neoplasm on contrast-enhanced T1 MR images. In 1990 the triple criteria for DTS were established by Goldsher et al. as: 1. Presence of at least two consecutive sections through the tumor at the same site in more than one imaging plane; 2. Greatest thickness adjacent to the tumor and tapering away from it; 3.Enhancement more intense than that of the tumor itself. Oedema: The probable etiologies of peritumoral oedema include tumor size, histologic subtypes, vascularity, venous stasis, type of arterial supply, sex hormone receptors, secretory activity, inflammation (lymphocytes and macrophage infiltrates), or brain invasion .
The typical radiological signs for extra-axial location of the lesion are better seen on MRI and there are: 1. broad dural base; 2. cortical buckling" of the underlying brain; 3. displace and expand subarachnoid space; 4. "cerebrospinal fluid cleft" 5. displaced subarachnoid vessels 6.bony reaction
Differential diagnosis of parasellar lesions: 1.Pituitary adenoma 2. Aneurysm 3. Craniopharyngioma 4. Glioma 5. Hamartoma 6. Germinoma, 7. Chordoma 8. Metastases.
REFERENCE:
1. Anne G. Osborn, Susan I. Blaser, Karen L. Salzman, Gregory L. Katzman, Gary A. Hedlund, James A. Cooper, Blaise V. Jones et al. Diagnostic Imaginig Brain, 2004; 997-999 2.Walter Kucharczyk, Marieke Hazewinkel et al. Sella Turcica and Parasellar Region, 2008; http://radiologyassistant.n 3.Intracranial meningiomas: an easy CT and MRI diagnosis? https://dx.doi.org/10.1594/ecr2015/C-1257
Findings
T1 isointense, T2 hyperintense lesion involving right parasellar region with sellar extension and causing compression and displacement of pituitary gland.It is noted extending into right cavernous sinus, right superior orbital fissure, completely encasing and narrowing the cavernous segment of right internal carotid artery. on contrast administration, the lesion shows avid homogenous enhancement with adjacent dural enhancement associated with thickening reflecting dural tail sign.
Discussion
Meningiomas are the most common benign intracranial tumor. They originate from arachnoid cap cells. Although the majority of meningiomas are benign, these tumors can grow slowly until they are very large if left undiscovered, and, in some locations, can be severely disabling and life-threatening. Common locations of meningiomas: Convexity meningioma 20% Parasagittal/falcine meningioma 25% Sphenoid wing 20% Olfactory groove 10% Suprasellar/Parasellar 10% Posterior fossa/ cerebello-pontine angle meningioma 10% Intraventricular 2% Intraorbital < 2% Tentorial < 2% Foramen magnum meningioma < 2% Morphological types of meningiomas: 1.globose = globular, well-demarcated neoplasm, with wide dural attachment 2.en plaque = sheet-like extension covering dura without parenchymal invagination 3.intraosseous meningioma = a subtype of primary extradural meningiomas 4.intraventricular 5.Lipomatous CT and MRI semiology of meningiomas CT: Meningioma is a well-defined broad-based extra-axial mass, hyperdense on NECT, with homogeneous enhancement, and frequent calcifications that are seen on CT (25%). Also bone erosion or hyperostosis can be associated with meningiomas and is well appreciated on CT MRI: On T1 Wi meningiomas are generally isointense to gray matter, iso-/ or hyperintense to gray matter on T2 Wi and demonstrate intense enhancement on T1 Wi. A focal thickened collar of enhancement can often be found adjacent to the tumor's dural attachment. This is the "dural tail" sign which histologically can be associated with tumor infiltration or merely inflamation. Dural tail sign” (DTS), “dural thickening”, “meningeal sign” are similar terms describing thickening of the dura adjacent to an intracranial neoplasm on contrast-enhanced T1 MR images. In 1990 the triple criteria for DTS were established by Goldsher et al. as: 1. Presence of at least two consecutive sections through the tumor at the same site in more than one imaging plane; 2. Greatest thickness adjacent to the tumor and tapering away from it; 3.Enhancement more intense than that of the tumor itself. Oedema: The probable etiologies of peritumoral oedema include tumor size, histologic subtypes, vascularity, venous stasis, type of arterial supply, sex hormone receptors, secretory activity, inflammation (lymphocytes and macrophage infiltrates), or brain invasion .
The typical radiological signs for extra-axial location of the lesion are better seen on MRI and there are: 1. broad dural base; 2. cortical buckling" of the underlying brain; 3. displace and expand subarachnoid space; 4. "cerebrospinal fluid cleft" 5. displaced subarachnoid vessels 6.bony reaction
Differential diagnosis of parasellar lesions: 1.Pituitary adenoma 2. Aneurysm 3. Craniopharyngioma 4. Glioma 5. Hamartoma 6. Germinoma, 7. Chordoma 8. Metastases.
REFERENCE:
1. Anne G. Osborn, Susan I. Blaser, Karen L. Salzman, Gregory L. Katzman, Gary A. Hedlund, James A. Cooper, Blaise V. Jones et al. Diagnostic Imaginig Brain, 2004; 997-999 2.Walter Kucharczyk, Marieke Hazewinkel et al. Sella Turcica and Parasellar Region, 2008; http://radiologyassistant.n 3.Intracranial meningiomas: an easy CT and MRI diagnosis? https://dx.doi.org/10.1594/ecr2015/C-1257
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!