Spinal canal meningioma mimicking posterior fossa ischemia on CT perfusion: A CT perfusion pitfall

Abstract

The recent approach to treat acute stroke is to extend treatment window in patients with salvageable peri-infarct ischemia which increases the application of the perfusion imaging, specifically computed tomography perfusion (CTP). In this paper, I am presenting a case of left middle cerebral artery infarction which was evaluated by CTP under “code stroke.” The patient had an incidental spinal canal meningioma which was out of field of view in CTP but mimicked right cerebellar ischemia on CTP. Although ischemia has been previously reported within the peripheral parenchymal edema surrounding a meningioma, in this patient there was no evidence of edema in the right cerebellum on magnetic resonance imaging. I believe the CTP findings are secondary to steal phenomena at right vertebral artery or compression upon the venous plexus. Recently, by using modern computed tomography scanners, it is common to cover the entire brain in CTP. The emergency radiologist should be aware of this pitfall that spinal canal pathologies which are out of field of view can mimic posterior fossa ischemia.

Clinical application of brain perfusion imaging in detecting stroke mimics: A review

“…Specific deconvolution methods may be able to correct these errors 26 Perfusion abnormalities of the posterior fossa should be interpreted with caution as they can erroneously result from pathologies within the spinal canal 101 What remains a challenge with perfusion imaging is that while perfusion of the brain tissue is a dynamic process, perfusion imaging is only able to depict the hemodynamic status of a brain region only at the time of imaging, which is a relatively short period of time 15 …”

“…Specific deconvolution methods may be able to correct these errors 26. e. Perfusion abnormalities of the posterior fossa should be interpreted with caution as they can erroneously result from pathologies within the spinal canal 101.…”