Presentation
Persistent headache.
Patient Data
A well-defined extra-axial dural-based space-occupying lesion is seen in the region of the falx cerebri. It displays intermediate signal intensity on both T1 and T2 and a relatively high signal on FLAIR WIs. After contrast administration, it shows homogenous enhancement. It shows a relatively high signal on DWIs and a low signal on the ADC maps reflecting diffusion restriction. It is seen surrounded by a mild degree of vasogenic edema. An increased calvarial thickness is seen adjacent to the lesion. These findings are suggestive of meningioma with high cellularity.
The interrupted middle portion of the superior sagittal sinus denotes invasion by the lesion.
The lesion shows spotty calcifications and adjacent calvarial hyperostosis.
Case Discussion
Meningiomas are the most common primary brain tumor. Meningiomas often occur in the supratentorial region, especially along the falx. Diffusion WIs and ADC maps are important in differentiating typical low-grade meningiomas from atypical high-grade meningiomas. Atypical meningiomas often exhibit high cellularity which is reflected by decreased water diffusion rates and decreased ADC values. Parasagittal meningiomas can invade and change the direction of blood flow through the venous sinuses. MRV is a useful tool to detect venous sinuses invasion.
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