Double meningioma

Case contributed by Graziana Agostinelli
Diagnosis almost certain


Hyposthenia of the left side, dysarthria and headaches.

Patient Data

Age: 60 years
Gender: Female

FLAIR and TSE-T2w axial and coronal images show compression of frontal horns and midline 7 millimeters left shift caused by double extra-axial masses.

The first one (LL axis 7,5 centimeters, CC axis 5,5 centimeters, AP axis 5,5 centimeters) develops bilaterally from anterior falx in median anterior frontal region; it appears slightly hyperintense in T2 weighted images, hysointense to the sorrounding cerebral parenchyma in FLAIR images and contains a calcific component well depicted by SWI images; CBF and CBV maps and values show focal hyperperfusion, confirmed by the colorimetrics pASL maps. This finding is thereby a match for a fibroblastic meningioma.

The second one (LL axis 5 centimeters, CC axis 4,8 centimeters, AP axis 5,7 centimeters) shows marked hyperintensity in T2w and FLAIR images, poor calcific component in SWI images, wide right dural fronto-parietal attachment with patchy enhancement and dural tail in Gd-T1w images, strong neovascularization and high values of CBV and CBF in DSCpMR and in the colorimetric pASL maps. These findings suggested a diagnosis of angioblastic meningioma.

TOF-MRA shows antero-posterior and dislocation of both ACAs and pericallosal arteries.

Case Discussion

This is a case where two different subtypes of meningioma can be found in the same patient. The exam was performed with a 3T MRI.

The patient has undergone surgery and the frontal mass has been resected. The histological results suggest a WHO I grade meningothelial meningioma.

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