Article Figures & Data
Figures
- FIG 1.
Four different rim-enhancement patterns at the tumor-brain interface on the CE-FLAIR sequence (arrows). A, Complete rim enhancement (CE-FLAIR rim sign). B, Rim enhancement of ≥50% but <100%. C, Rim enhancement of <50%. D, No visible rim enhancement. The pathologic results of A, B, and C are meningioma, and D is plasmacytoma.
- FIG 2.
CE-FLAIR rim sign in meningiomas at the cerebellomedullary cistern (A) and parafalcine region (B).
- FIG 3.
A, Anaplastic meningioma (WHO grade III). CE-FLAIR (A) sequence demonstrates a large extra-axial mass with cortical breakthrough involving the left middle skull base and left temporal skull with the CE-FLAIR rim sign (white arrows). Malignant soft-tissue tumor was the favored diagnosis in the initial report. The pathologic result is anaplastic meningioma (WHO grade III). A malignant dural-based mass on CE-FLAIR (B) and CE-T1WI fat suppression (C) sequences shows an extra-axial heterogeneously enhancing mass at the bilateral frontal convexities that had invaded the anterior-superior sagittal sinus and demonstrates the CE-FLAIR rim sign (white arrows), accompanied by focal leptomeningeal enhancement (asterisk) and adjacent brain parenchymal invasion (black arrow). Meningioma was the favored diagnosis in the initial report. The pathologic result was metastatic mucoepidermoid carcinoma.
- FIG 4.
A, CE-T1WI fat suppression sequence demonstrates an extra-axial mass at the right frontoparietal convexity with a dural tail sign that resembles a meningioma. B, CE-FLAIR sequence. No rim enhancement on the tumor-brain interface is observed. Meningioma was the favored diagnosis in the initial report. The pathologic result was osteosarcoma.
Tables
Variables Meningiomas (n = 102, 76.7%) Malignant Dural-Based Tumors (n = 31, 23.3%) Age (mean) (yr) 51.96 (SD, 10.69) 50.03 (SD, 20.81) Sex Female 85 (83.3%) 15 (48.4%) Male 17 (16.7%) 16 (51.6%) Size (mean) (cm) 4.37 (SD, 1.91) 4.5 (SD, 2.2) WHO grade I 72 (70.6%) – II 22 (21.6%) – III 8 (7.8%) – Location Convexity 24 (23.5%) 19 (61.2%) Sphenoid wing 20 (19.6%) 3 (9.6%) Petroclival 18 (17.6%) 1 (3.3%) Parafalcine 13 (12.7%) – Cavernous sinus 9 (8.8%) 3 (9.6%) Cerebellopontine angle 6 (5.8%) 1 (3.3%) Suprasellar 9 (8.8%) – Foramen magnum 2 (1.9%) – Olfactory groove 1 (0.9%) – Orbit – 3 (9.6%) Prepontine – 1 (3.3%) Note:—The en dash (–) indicates none.
Pathology No. of Cases (n = 31) Metastasis 18 (58%) Adenoid cystic carcinoma 5 Lung (non-small cell) 3 Breast (invasive ductal carcinoma) 2 Squamous cell carcinoma at scalp 2 Urachal carcinoma 1 Thyroid (follicular carcinoma) 1 Mucoepidermoid carcinoma 1 Nasopharynx (SCCA) 1 Base of tongue (SCCA) 1 Colon (adenocarcinoma) 1 Plasmacytoma/multiple myeloma 6 (19.3%) Ewing sarcoma 2 (6.4%) Lymphoma (non-Hodgkin) 2 (6.4%) Osteosarcoma 1 (3.4%) Spindle cell carcinoma 1 (3.4%) Atypical teratoid/rhabdoid tumor 1 (3.4%) Note:—SCCA indicates squamous cell carcinoma.
Variables Sensitivity Specificity PPV NPV Accuracy Dural tail sign 98.0% 19.4% 80.0% 75.0% 79.7% Marrow edema 79.2% 33.3% 92.7% 13.0% 75.2% Hyperostosis 74.5% 100.0% 100.0% 54.4% 80.5% Complete rim enhancement on CE-FLAIR 89.2% 93.5% 97.8% 72.5% 90.2% Homogeneous enhancement on T1WI 73.5% 71.0% 89.3% 44.9% 72.9% Variables Sensitivity Specificity PPV NPV Accuracy Lack of dural tail 19.4% 98.0% 75.0% 80.0% 79.7% Cortical breakthrough 67.7% 95.1% 80.8% 90.7% 88.7% Leptomeningeal enhancement 32.3% 100.0% 100.0% 82.9% 84.2% Heterogeneous enhancement on T1WI 71.0% 73.5% 44.9% 89.3% 72.9% Hypointense signal on T2WI 53.3% 86.2% 66.7% 78.1% 75.0%
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