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MR imaging and spectrocopy of intraventricular meningiomas

Case Study
Dr. Bernabeu, Angela Inscanner • Spain

Patient history

A 47-year-old female patient was admitted at the neurological unit after two months of difficulty in reading. The family history was negative for neurological diseases and the patient did not present any antecedent of interest, no evidence of infection, toxic habits or drug abuse. The neurological examination showed mild aphasia and right homonymous hemianopsia.

Imaging parameters

Philips Intera 1.5T, Release  11.4.

Standard quadrature head coil.

MR results

 <br>

 Single voxel MR spectroscopy and spectroscopic imaging
<br><br><br>
Single voxel MR spectroscopy and spectroscopic imaging


Diagnosis

The MRI showed the existence of two intraventricular lesions (5 cm in the left side, 2.5 cm in the right side) with different appearance. Both lesions presented perilesional edema.


No diffusion restriction was observed (images not shown).
Both lesions showed contrast agent enhancement (Gadovist).


Single voxel MR Spectroscopy showed, despite the different appearance in the MR imaging study, a  similar
metabolic profile which suggested Meningioma. Metabolite maps (multivoxel MRS) did not show evidence of infiltration, being both lesions well demarcated.

Excision of the lesions was performed separately (left hemisphere first), over a period of 4 months.  The histopathology revealed brain Meningioma I (OMS) for both lesions.

Clinical significance

Intraventricular brain lesions present a complex surgical approach and may have different etiologies (from low-grade to highly aggresive). This is why accurate diagnosis is very important.

MRS is a very useful tool in the differential diagnosis of brain lesions.

Impact of imaging

This example shows how two lesions of identical etiology may present a very different appearance in MR imaging. It also shows how MR spectroscopy may help to better identify the lesion etiology.



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Case Study
Intera 1.5T
Release 11
Standard
Brain, meningioma, MRS, MRSI, Neuro, Spectroscopy
 

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