0:00

I'm here with my brilliant young colleague,

0:02

Dr. Ben Laser.

0:03

We're talking about the vascular makeup of meningiomas.

0:06

This is a 43-year-old man with a huge falcine meningioma

0:09

with left-sided symptoms from compression.

0:12

The meningioma is on the right side.

0:14

It's a huge falcine meningioma seen on T1,

0:17

T1 C+ and T1 coronal.

0:19

So this is an axial, this is a coronal,

0:21

T1 C+.

0:23

And this lesion demonstrates some rather intense

0:26

enhancement with some dural enhancement.

0:28

We talked previously about the mother-in-law sign.

0:31

Both of us are successfully married.

0:33

Mother-in-laws are terrific.

0:35

They come early to help you out with the kids,

0:37

but they also stay late to babysit

0:39

to help you out with the kids.

0:40

Some people say that the enhancement of a meningioma

0:43

is intense, kind of like your mother-in-law.

0:46

But the question that I have is why?

0:48

And you know there are some normal areas of

0:50

the brain that normally enhance,

0:52

like the dura and the choroid plexus,

0:55

and the area postrema and the pineal gland.

0:59

So why do meningiomas have this intense enhancement,

1:03

not unlike some normal structures?

1:05

So these normal structures that Dr. Pomeranz

1:07

has just described, all have a type

1:09

of fenestration in their capillaries.

1:11

There's three different types of capillaries.

1:13

You have the continuous capillary,

1:14

you have the sinusoidal capillaries,

1:16

and then you have the fenestrated capillaries.

1:18

The fenestrated capillaries, in all these areas, take up

1:21

enhancement and allow the blood that has the contrast

1:26

to enhance these regions.

1:26

So, they're more leaky.

1:27

So they're more leaky.

1:28

Essentially, the vessels are leaky,

1:30

and that's why the meningioma enhances

1:33

so rapidly and avidly.

1:35

So, basically what happens is

1:36

these normal blood vessels

1:38

that are different, the subtype of capillary

1:40

known as autochthonous blood supply in these areas become

1:44

too proliferative in the meningioma and allow very rapid

1:48

leakage of gadolinium or the contrast

1:50

agent into the lesion,

1:52

producing a mass that exhibits the mother-in-law sign,

1:55

comes early, stays late.

1:57

It's intense.

1:58

Let's move on, shall we?

Case: Meningioma Enhancement

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Pro Tip: Click on a word in the transcript to jump to that point in the video

0:00

I'm here with my brilliant young colleague,

0:02

Dr. Ben Laser.

0:03

We're talking about the vascular makeup of meningiomas.

0:06

This is a 43-year-old man with a huge falcine meningioma

0:09

with left-sided symptoms from compression.

0:12

The meningioma is on the right side.

0:14

It's a huge falcine meningioma seen on T1,

0:17

T1 C+ and T1 coronal.

0:19

So this is an axial, this is a coronal,

0:21

T1 C+.

0:23

And this lesion demonstrates some rather intense

0:26

enhancement with some dural enhancement.

0:28

We talked previously about the mother-in-law sign.

0:31

Both of us are successfully married.

0:33

Mother-in-laws are terrific.

0:35

They come early to help you out with the kids,

0:37

but they also stay late to babysit

0:39

to help you out with the kids.

0:40

Some people say that the enhancement of a meningioma

0:43

is intense, kind of like your mother-in-law.

0:46

But the question that I have is why?

0:48

And you know there are some normal areas of

0:50

the brain that normally enhance,

0:52

like the dura and the choroid plexus,

0:55

and the area postrema and the pineal gland.

0:59

So why do meningiomas have this intense enhancement,

1:03

not unlike some normal structures?

1:05

So these normal structures that Dr. Pomeranz

1:07

has just described, all have a type

1:09

of fenestration in their capillaries.

1:11

There's three different types of capillaries.

1:13

You have the continuous capillary,

1:14

you have the sinusoidal capillaries,

1:16

and then you have the fenestrated capillaries.

1:18

The fenestrated capillaries, in all these areas, take up

1:21

enhancement and allow the blood that has the contrast

1:26

to enhance these regions.

1:26

So, they're more leaky.

1:27

So they're more leaky.

1:28

Essentially, the vessels are leaky,

1:30

and that's why the meningioma enhances

1:33

so rapidly and avidly.

1:35

So, basically what happens is

1:36

these normal blood vessels

1:38

that are different, the subtype of capillary

1:40

known as autochthonous blood supply in these areas become

1:44

too proliferative in the meningioma and allow very rapid

1:48

leakage of gadolinium or the contrast

1:50

agent into the lesion,

1:52

producing a mass that exhibits the mother-in-law sign,

1:55

comes early, stays late.

1:57

It's intense.

1:58

Let's move on, shall we?

Report

Faculty

Stephen J Pomeranz, MD

Chief Medical Officer, ProScan Imaging. Founder, MRI Online

ProScan Imaging

Lesson

Introduction

Lesson

Meningiomas

Lesson

Non-glial Tumors

Lesson

2021 WHO CNS Tumor Classification

Lesson

Gliomas

Lesson

Pediatric Brain Tumor Cases

Case: Meningioma Enhancement