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Utility of dynamic susceptibility contrast MRI for differentiation between paragangliomas and meningiomas in the cerebellopontine angle and jugular foramen region

      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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