Abstract
PurposeUsing conventional magnetic resonance imaging (MRI) techniques, the imaging features of meningiomas and dural metastases overlap and a differentiation between these tumor entities therefore remains difficult, particularly in patients with a known primary neoplasm. The purpose of this study was to explore the potential role of normalized vascular intratumoral signal intensity values (nVITS) obtained from pulsed arterial spin labeling (PASL) to differentiate between meningiomas and dural metastases.MethodsIn this study PASL was performed in 46 patients with meningiomas (n = 30) and dural metastases (n = 16) on a 3T scanner, in addition to the routine diagnostic imaging protocol. The ratio between the vascular signal intensity of the tumor and the contralateral normal white matter obtained by PASL images was defined as nVITS.ResultsMeningiomas showed significantly higher nVITS values compared to dural metastases (p < 0.001). The optimal nVITS cut-off value to differentiate between the 2 tumor entities was 1.989, with 100% sensitivity and 81.2% specificity.ConclusionThe nVITS values obtained by PASL provide a fast and noninvasive MRI technique with which to differentiate between meningiomas and dural metastases in a routine clinical setting based on tumor vascularity.
Highlights
Meningiomas are the most common primary intracranial tumors in adults, representing approximately one third of all intracranial neoplasms [1, 2]
Both are characterized as an extra-axial mass, which is isointense to grey matter on T1-weighted images and shows vivid contrast enhancement on T1-weighted, post-contrast images, including the dura, which is called the dural tail sign [11, 12]; contrast enhancement represents the disruption of the blood brain barrier rather than tumor neovascularization, which is known to be markedly intensified in meningiomas in contrast to the most common dural metastases, those that derive from a primary breast, prostate or lung carcinoma [13, 21]
The results of this study show that pulsed arterial spin labeling (PASL) can provide useful information that can differentiate between meningiomas and dural metastases based on tumor vascularity
Summary
Meningiomas are the most common primary intracranial tumors in adults, representing approximately one third of all intracranial neoplasms [1, 2]. They arise from meningothelial cells of the arachnoid and present as avid, homogeneous, contrast-enhancing dural masses on computed tomography (CT) and magnetic resonance imaging (MRI) [3]. Dural metastases occur much less frequently, representing approximately 1% of intracranial tumors and approximately 10% of patients who suffer from advanced systemic cancer [4]. The most common primary neoplasm from which dural metastases develop are breast, prostate, kidney, lung and head and neck carcinomas [5]. With conventional MRI methods, the differentiation between meningiomas and du-
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