Meningeal pathology with MRI: a practical approach

This poster was previously presented in Spanish at the 2012 Congreso Nacional SERAM (Granada)

Congress:

ECR 2013

Poster Number:

C-1083

Type:

Educational Exhibit

Keywords:

MR, Neuroradiology brain

Authors:

P. Martín Medina, E. Feliu Rey, F. Ballenilla Marco, E. Calabuig Barbero, J. I. Gallego León, M. García Carbonell; Alicante/ES

DOI:

10.1594/ecr2013/C-1083

DOI-Link:

https://dx.doi.org/10.1594/ecr2013/C-1083

Fig. 6: Leptomeningeal carcinomatosis in a patient with breast cancer. Axial and...

Fig. 9: Atypical meningioma (WHO grade III). Enhanced T1 spin echo images. A huge...

Fig. 25: Intracranial hypotension syndrome.

Table 1: Meningeal Pathology. Diagnostic algorithm. Patterns and questions to be asked.

Learning objectives

1. To carry out an approach to the diagnose algorithm of meningeal pathology with MR, by describing the protocols and main manifestations of that pathology. 2. To show, with a practical point of view, the affected patterns in MR and to provide clues in order to make a precise radiologic report. 3. To check the cases reported in our hospital unit.

Background

I. INTRODUCTION Meningeal anatomy The meninges that envelop the brain consist in three layers: the dura mater, the arachnoid mater and the pia mater. The outermost layer is the dura mater or pachymeninx which lies closest to the calvaria. Epidural space is a potential space between the outer layer of the dura mater and the inner layer of the skull. The middle element of the meninges is the arachnoid mater that is attached to the overlying dura mater with a virtual space between both layers,...

Imaging findings OR Procedure details

A 1.5 Tesla MRI was used to perform the exams. The MR imaging protocol included systematically all the established sequences for brain examinations completed with sequences after gadolinium administration: axial T1 spin echo and T1-3D acquisition. FLAIR and T1-FLAIR images and fat supression techniques were used in selected cases in which they were necessary.

Conclusion

In the differential diagnosis of meningeal pathology in MR, identification of the pattern of presentation and associated findings, together with the clinical history, can give us the key to establishing the correct diagnosis or determine when biopsy or complementary studies are necessary.

References

Smirniotopoulos J, Murphy F et al. From the archives of the AFIP: Patterns of contrast enhancement in the brain and meninges. Radiographics 2007; 27:525-551. Tokumanu A, Obata T et al. Intracranial meningeal involvement in Churg-Strauss syndrome. AJNR 2002; 23:221-224. Hirota T, Ishihara K. Delayed post-contrast fluid-attenuated inversion recovery image for depicting meningeal carcinomatosis. The British Journal of Radiology 2004; 77:528-531. Galassi W, Phuttharak W. Intracranial meningeal disease: comparison of contrast-enhanced MR Imaging with fluid-attenuated inversion recovery and fat-suppressed T1-wieghted sequences. AJNR 2005; 26:553-559. Escott E....