Diagnosing dural metastases: the value of 1 H magnetic resonance spectroscopy

Abstract

The purpose of this study was to assess the value of MRI, MR spectroscopy (MRS) and intra-arterial angiography in the preoperative diagnosis of extra-axial dural-based masses. We prospectively studied 54 patients who underwent preoperative MRI, MRS and angiography. Histologically there were 50 meningiomas and four dural metastases. MRI and angiography did not allow reliable differentiation between meningiomas and metastases. MRS showed elevated choline/creatine ratios in both meningiomas and metastases, but there were prominent lipid signals in all metastases and a lactate peak in two. This spectroscopic pattern was not found in meningiomas. However, following embolisation, they showed similar spectra, due to ischaemia and necrosis. We therefore believe MRS to be valuable in differential diagnosis of dural metastases and meningiomas prior to embolisation.

Dural tail sign adjacent to different intracranial lesions on contrast-enhanced MR images

“…In our study we also had one patient with Wegener's granulomatosis with DTS present (Figure 13). DTS has also been reported in dural-based metastasis and cortical intraparenchymal metastasis, mostly in prostate and neuroblastoma metastasis (9,39), but in our study in the 13 cases of metastasis we did not note DTS. Also we did not fi nd DTS in any of the 3 cases of lymphomas.…”

Potential of F-18 PET/CT in the Detection of Leptomeningeal Metastasis

“…formed to evaluate the tumor's vasculature. MRA showed no significant intracranial arterial blood supply to the right infratentorial, dural-based mass, a finding non-discriminatory for distinguishing meningioma from dural metastasis 6 . On hospital day 3, the patient developed significant bilateral lower extremity weakness graded as 3/5.…”

Cancer metastases to meningioma: apropos two cases

“…RCC and its metastases are hypervascular lesions and a high enhancement after contrast medium administration is typically noted. However, the same enhancement pattern is observed in meningioma with necrotic changes and cystic degeneration [3,18]. It is extremely difficult to distinguish two different tumours in one pathologi cal mass without histological examination, especial ly in the case of a similar type of vasculature [14].…”

“…Moreover, diffusion and perfusion MRI techniques will enable diagnos tic efficacy. However, despite modern neuroimaging, pathological examination is crucial for correct diag nosis [3,18,30].…”

“…In correct diagnosis of TTTM, it is necessary to differentiate with a rare phenomenon of collision or fusion of primary separate growth of "host" tumour and metastatic focus [2]. The role of modern neuroimaging, like functional imaging and MR spectroscopy may be helpful in preoperative diagnosis of TTTM lesions [3,18,23].…”