Meningioma (Brain)

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Diagnosis Definition

Meningioma is the most common primary brain tumor; it arises from the meninges, grows slowly, and is often found incidentally on CT or MR imaging
95% of Meningiomas are benign and 5-15% are multiple, especially in patients with neurofibromatosis type 2
The incidence is greater in women and in patients over age 60
Meningiomas can become quite large and result in bony changes of hyperostosis, permeative destructive changes, or erosion

Imaging Findings

Meningiomas typically appear as lobular, extra axial masses with well-circumscribed margins
They typically have a broad-based dural attachment and, if sufficiently large, inward displacement of the cortical grey matter
On MRI, meningiomas are typically isointense to slightly hypointense relative to grey matter on the T1-weighted sequence and isointense to slightly hyperintense relative to grey matter on T2
Meningiomas typically demonstrate avid, homogeneous contrast enhancement

Pearls

The differential diagnosis of intracranial meningioma includes esthesioneuroblastoma, sinonasal undifferentiated tumor, osteoma, metastasis, hemangioma, and fibrous dysplasia
Meningiomas located at the skull base have the potential to encase the carotid arteries and cause luminal narrowing; however, cerebrovascular insufficiency is exceedingly rare
Extra axial location is suggested by the presence of a CSF cleft between the tumor and the underlying brain cortex
Calcification is typically best demonstrated on CT, with variable reported rates of occurrence

References

Buetow MP, Buetow PC, Smirniotopoulos JG. Typical, atypical, and misleading features in meningioma. RadioGraphics 1991; 11(6):1087–1106
Watts J, Box G, Galvin A, et al. Magnetic resonance imaging of meningiomas: a pictorial review Insights Imaging 2014; 5(1):113–122

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