Usefulness of turbo-fluid-attenuated inversion-reovery (tFLAIR) sequence in diagnosing meningioma.

PURPOSE: We evaluated qualitatively and quantitatively the usefulness of turbo-FLAIR (tFLAIR) in diagnosing meningioma in comparison with the T2-weighted turbo spin echo (T2W-TSE) sequence. MATERIALS AND METHODS: Forty-eight patients diagnosed with meningioma were studied. In the qualitative study, we evaluated tumor delineation, contrast (Co) of tumor-to-CSF (cerebrospinal fluid), Co of tumor-to-brain parenchyma, Co of peripheral edema-to-brain parenchyma, and detectability of tumor margin. In quantitative study-1, using signal intensity (SI), we measured SI and calculated Co-SI of tumor-to-gray matter, Co-SI of tumor-to-white matter, Co-SI of peripheral edema-to-white matter, and Co-SI of tumor-to-CSF. In quantitative study-2, using film density, we measured density (De) on hard-copy film images and calculated Co-De for the same items as in quantitative study-1. RESULTS: In the qualitative study, tFLAIR was superior to T2W-TSE in tumor delineation, Co of tumor-to-CSF, Co of tumor-to-brain parenchyma, and Co of peripheral edema-to-brain parenchyma. In quantitative study-1, tFLAIR was superior to T2W-TSE in Co-SI of tumor-to-CSF, however, T2W-TSE was superior to tFLAIR in Co-SI of tumor-to-white matter. In quantitative study-2, tFLAIR was superior to T2W-TSE in all Co-De. CONCLUSION: tFLAIR was superior to T2W-TSE in the depiction of meningioma.

Remitting seronegative symmetric synovitis with pitting edema: scintigraphic and magnetic resonance imaging findings.

Remitting seronegative symmetric synovitis with pitting edema (RS3PE) was first reported by McCarty et al in 1985 and refers to a rheumatologic set of symptoms with acute onset, with no erosive bone lesions, with seronegative findings, affecting the elderly more frequently, and showing an excellent prognosis with low-dose steroid therapy. Although these characteristics make it possible to differentiate it from rheumatoid arthritis and rheumatic polymyalgia, there have been very few reports on the imaging findings. The authors present scintigraphic and magnetic resonance images in a case of RS3PE.

Evaluation of the tumor-brain interface of intracranial meningiomas on MR imaging including FLAIR images.

PURPOSE: The usefulness of fluid-attenuated inversion recovery (FLAIR) imaging for the evaluation of brain diseases has been reported. The purpose of this study was to evaluate the brain-meningioma interface with MRI including FLAIR imaging. MATERIALS AND METHODS: This study involved 48 patients with 50 intracranial meningiomas. We retrospectively evaluated the brain-meningioma interface by various imaging method including FLAIR. If a thin layer with a signal intensity different from that of the tumor and brain was observed in the areas of the tumor-brain interface in T(1)-weighted IR (T(1)WIR) and T(2)-weighted turbo SE (T(2)WTSE) images, we defined this structure as the rim. The presence or absence of the rim and the signal intensity were evaluated, and the length and the signal intensity of the rim observed with FLAIR and contrast-enhanced T(1)WIR (CE-T(1)WIR) images were evaluated. RESULTS: In 35 of the 50 lesions (70.0%), the rim was observed in the tumor-brain interface as a layer of low signal intensity in T(1)WIR images and high signal intensity in T(2)WTSE images. In 13 lesions (26.0%), no rim was detected. Flow voids were observed at the tumor-brain interface in 20 of the 50 lesions (40.0%). No rim showed a low signal intensity of the tumor-brain interface in both T(1)WIR and T(2)WTSE images. The rim exhibited an iso-to-high signal intensity compared to the tumor parenchyma in FLAIR images and an enhanced signal intensity in CE-T(1)WIR images. In contrast to T(1)WIR images, the rim in FLAIR images tended to be identified across the entire circumference. CONCLUSION: The rim at the brain-meningioma interface revealed as low signal intensity in T(1)WIR images and high signal intensity in T(2)WTSE images, which was conventionally considered to be the CSF cleft, was often revealed in FLAIR images as high signal intensity compared to the tumor parenchyma, and an enhanced signal intensity in CE-T(1)WIR images. Therefore, the presence of CSF in such rims is unlikely, and the rims might reflect the capsule structure of the tumor surface.

Prediction of tumor-brain adhesion in intracranial meningiomas by MR imaging and DSA.

OBJECTIVES: The purpose of this study was to evaluate the usefulness of MRI (magnetic resonance imaging) and DSA (digital subtraction angiography) by using preoperative MRI and DSA findings in the examination of meningiomas before excision. In particular, we focused on their usefulness in predicting tumor-brain adhesion during surgery. MATERIALS AND METHODS: The subjects were 36 patients with intracranial meningioma who underwent tumor excision at which time neurosurgeons examined the tumor-brain adhesion. Two neurosurgeons evaluated the degree of tumor-brain adhesion from operation records and videotapes recorded during surgery. Two neuroradiologists retrospectively evaluated the preoperative MRI findings including tumor diameter, signal intensity of the tumor parenchyma obtained with T(2)-weighted imaging (T(2)WI), characteristics of the tumor-brain interface, and degree of peritumoral brain edema. The vascular supply was also evaluated from the preoperative DSA findings. The relationship between these MRI and DSA findings and the degree of tumor-brain adhesion during surgery as classified by the neurosurgeons was statistically analyzed. RESULTS: The degree of peritumoral brain edema and the shapes and characteristics of the tumor-brain interface, including the findings of FLAIR (fluid-attenuated inversion recovery) imaging and vascular supply observed by DSA, were significantly correlated with tumor-brain adhesion. In particular, the shapes and characteristics of the tumor-brain interface as observed by T(1)-weighted imaging (T(1)WI), T(2)WI, and FLAIR, respectively, as well as the vascular supply observed by DSA, were closely correlated with the degree of tumor-brain adhesion encountered during surgery. According to these results, we developed a method of predicting tumor-brain adhesion that considers the shape of the tumor-brain interface revealed by MRI and the vascular supply revealed by DSA. CONCLUSIONS: We retrospectively examined the findings of MRI and DSA performed before excision of meningioma and clarified the relationship between the findings and tumor-brain adhesion. We speculated that tumor-brain adhesion can be accurately and simply predicted before surgery with a new method that considers the shape of the tumor-brain interface observed by MRI and vascular supply observed by DSA.