Highlights
- •DSC-MRI can help to differentiate paragangliomas from meningiomas with TTP and rCBV while not aiding in differentiating between meningioma subtypes.
- •The presence of flow voids and cystic/necrotic changes can aid in differentiating the two tumor types.
- •Adding DSC-MRI to the head and neck protocol can assist in the appropriate clinical workup and treatment when conventional imaging is indeterminate for differentiation of the two tumors or DCE-MRI cannot be technically performed.
Abstract
Purpose
Differentiation of paragangliomas and meningiomas can be a challenge. This study aimed
to assess the utility of dynamic susceptibility contrast perfusion MRI (DSC-MRI) to
distinguish paragangliomas from meningiomas.
Methods
This retrospective study included 40 patients with paragangliomas and meningiomas
in the cerebellopontine angle and jugular foramen region between March 2015 and February
2022 in a single institution. Pretreatment DSC-MRI and conventional MRI were performed
in all cases. Normalized relative cerebral blood volume (nrCBV), relative cerebral
blood flow (nrCBF), relative mean transit time (nrMTT), and time to peak (nTTP) as
well as conventional MRI features were compared between the 2 tumor types and between
meningioma subtypes as appropriate. Receiver operating characteristic curve and multivariate
logistic regression analysis were performed.
Results
Twenty-eight meningiomas including 8 WHO grade II meningiomas (12 males, 16 females;
median age 55 years) and 12 paragangliomas (5 males, 7 females; median age 35 years)
were included in this study. Paragangliomas had a higher rate of cystic/necrotic changes
(10/12 vs 10/28; P = 0.014), a higher rate of internal flow voids (9/12 vs 8/28; P = 0.013), higher nrCBV (median 9.78 vs 6.64; P = 0.04), and shorter nTTP (median 0.78 vs 1.06; P < 0.001) than meningiomas. There was no difference in conventional imaging features
and DSC-MRI parameters between meningioma subtypes. nTTP was identified as the most
significant parameter for the 2 tumor types in the multivariate logistic regression
analysis (P = 0.009).
Conclusions
In this small retrospective study, DSC-MRI perfusion differences were observed between
paragangliomas and meningiomas, but not between grade I and II meningiomas.
Abbreviation:
DSC-MRI (Dynamic susceptibility contrast perfusion MRI), DCE-MRI (Dynamic contrast-enhanced MRI), WHO (World Health Organization), FLAIR (Fluid-attenuated inversion recovery), rCBV (Relative cerebral blood volume), rCBF (Relative cerebral blood flow), rMTT (Relative mean transit time), TTP (Time to peak), AIF (Arterial input function), ROI (Region of interest), ROC (Receiver operating characteristic curve)Keywords
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References
- Differential diagnosis of jugular foramen lesions.Skull Base. 2009; 19: 3-16https://doi.org/10.1055/s-0028-1103121
- Cerebellopontine angle masses: radiologic-pathologic correlation.Radiographics. 1993; 13: 1131-1147https://doi.org/10.1148/radiographics.13.5.8210595
- Primary jugular foramen meningioma: imaging appearance and differentiating features.AJR Am J Roentgenol. 2004; 182: 373-377https://doi.org/10.2214/ajr.182.2.1820373
- Jugular foramen tumors: clinical characteristics and treatment outcomes.Otol Neurotol. 2010; 31: 299-305https://doi.org/10.1097/MAO.0b013e3181be6495
- Extra-axial brain tumors.Handb Clin Neurol. 2016; 135: 275-291https://doi.org/10.1016/B978-0-444-53485-9.00015-5
- Paragangliomas of the head and neck.Neuroimaging Clin N Am. 2016; 26: 259-278https://doi.org/10.1016/j.nic.2015.12.005
- Head and neck paragangliomas: value of contrast-enhanced 3D MR angiography.AJNR Am J Neuroradiol. 2008; 29: 883-889https://doi.org/10.3174/ajnr.A0948
- 15 YEARS OF PARAGANGLIOMA: imaging and imaging-based treatment of pheochromocytoma and paraganglioma.Endocr Relat Cancer. 2015; 22: T135-T145https://doi.org/10.1530/ERC-15-0175
- Variants of meningiomas: a review of imaging findings and clinical features.Jpn J Radiol. 2016; 34: 459-469https://doi.org/10.1007/s11604-016-0550-6
- Role of intratumoral flow void signs in the differential diagnosis of intracranial solitary fibrous tumors and meningiomas.J Neuroradiol. 2016; 43: 325-330https://doi.org/10.1016/j.neurad.2016.06.003
- MR diffusion and dynamic-contrast enhanced imaging to distinguish meningioma, paraganglioma, and schwannoma in the cerebellopontine angle and jugular foramen.J Neuroimaging. 2022; 32: 502-510https://doi.org/10.1111/jon.12959
- Perfusion magnetic resonance imaging provides additional information as compared to anatomical imaging for decision-making in vestibular schwannoma.Eur J Radiol Open. 2016; 3: 127-133https://doi.org/10.1016/j.ejro.2016.05.005
- Precise discrimination between meningiomas and schwannomas using time-to-signal intensity curves and percentage signal recoveries obtained from dynamic susceptibility perfusion imaging.J Neuroradiol. 2021; 48: 157-163https://doi.org/10.1016/j.neurad.2020.09.008
- Diagnostic role of diffusion-weighted and dynamic contrast-enhanced perfusion MR imaging in paragangliomas and schwannomas in the head and neck.AJNR Am J Neuroradiol. 2021; 42: 1839-1846https://doi.org/10.3174/ajnr.A7266
- Diffusion-weighted and dynamic contrast-enhanced MRI to assess radiation therapy response for head and neck paragangliomas.J Neuroimaging. 2021; 31: 1035-1043https://doi.org/10.1111/jon.12875
- Neurofibromatosis type 2 versus sporadic vestibular schwannoma: the utility of MR diffusion and dynamic contrast-enhanced imaging.J Neuroimaging. 2022; 32: 554-560https://doi.org/10.1111/jon.12966
- American Society of Functional Neuroradiology MR perfusion standards and practice subcommittee of the ASFNR clinical practice committee. ASFNR recommendations for clinical performance of MR dynamic susceptibility contrast perfusion imaging of the brain.AJNR Am J Neuroradiol. 2015; 36: E41-E51https://doi.org/10.3174/ajnr.A4341
- Automatic selection of arterial input function using cluster analysis.Magn Reson Med. 2006; 55: 524-531https://doi.org/10.1002/mrm.20759
- Assessment of MR imaging and CT in differentiating hereditary and nonhereditary paragangliomas.AJNR Am J Neuroradiol. 2021; 42: 1320-1326https://doi.org/10.3174/ajnr.A7166
- Head and neck paragangliomas: clinical and molecular genetic classification.Clinics (Sao Paulo). 2012; 67 (Suppl 1): 19-28https://doi.org/10.6061/clinics/2012(sup01)05
- Contribution of perfusion-weighted magnetic resonance imaging in the differentiation of meningiomas and other extra-axial tumors: case reports and literature review.J Neurooncol. 2011; 103: 777-783https://doi.org/10.1007/s11060-010-0445-9
- Meningioma-related dural arteriovenous fistula fed via a vascular tumor bed: a case report and literature review.Clin Neurol Neurosurg. 2012; 114: 1010-1013https://doi.org/10.1016/j.clineuro.2012.01.017
- Perfusion MR imaging for differentiation of benign and malignant meningiomas.Neuroradiology. 2008; 50: 525-530https://doi.org/10.1007/s00234-008-0373-y
- Dynamic contrast-enhanced perfusion MR imaging measurements of endothelial permeability: differentiation between atypical and typical meningiomas.AJNR Am J Neuroradiol. 2003; 24: 1554-1559
- Validated imaging biomarkers as decision-making tools in clinical trials and routine practice: current status and recommendations from the EIBALL* subcommittee of the European Society of Radiology (ESR).Insights Imaging. 2019; 10: 87https://doi.org/10.1186/s13244-019-0764-0
Article info
Publication history
Accepted:
December 27,
2022
Received in revised form:
December 21,
2022
Received:
August 29,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
