Intratumoral microhemorrhage detection on susceptibility-weighted imaging can help in preoperative differentiation of cerebellopontine angle vestibular schwannomas from meningiomas: Correlation with pathology findings

Objectives: In this study, we aimed to evaluate whether intratumoral microhemorrhage detection on susceptibility-weighted imaging SWI could help in preoperative differentiation of cerebellopontine angle CPA vestibular schwannomas VSs from meningiomas. Patients and Methods: A total of 75 patients 32 males, 43 females; mean age: 45.5±16.7 years; range, 17 to 68 years consisting of 61 VSs and 14 meningiomas located in the CPA cistern were retrospectively analyzed. All patients underwent contrast-enhanced magnetic resonance imaging MRI using the SWI sequence. All images in our study were obtained with a 12-channel phased-array head coil on a 1.5-Tesla clinical scanner. The presence of intratumoral microhemorrhages on SWI sequence was evaluated by demonstrating blooming artifacts as punctate hypointense regions. Both magnitude and phase-contrast images were used to verify microhemorrhages. All patients in our patient cohort underwent surgery and resected tumor specimens were evaluated by pathology. Results: All VS cases in our cohort exhibited multiple hypointense small foci causing blooming artifact on magnitude and processed SWI images. In the meningioma population, typical MRI signal intensity characteristics, including an intense homogenous contrast enhancement, were observed. In all the meningioma cases, except for one, there was no blooming artifact due to intratumoral hemorrhage within the mass lesions on SWI images. In only one meningioma case, SWI revealed hypointense microhemorrhages within the mass lesion. Following surgical procedures and tumor resections, pathology specimens were evaluated and absence or presence of intratumoral microhemorrhages were detected. These results were significantly correlated with the SWI findings. We obtained 100% sensitivity, 92.8% specificity, and 98.6% accuracy in terms of differentiating VSs from meningiomas located in the CPA cistern by using the SWI sequence. Conclusion: Meningiomas and VSs are the two most common masses of the CPA cistern and, in some cases, it seems to be difficult to reach an accurate diagnosis with conventional MRI sequences. The SWI can be helpful to solve this problem by demonstrating whether intratumoral microhemorrhages are present or not within mass lesions and, thus, can help to assume a probable accurate diagnosis prior to surgery

Keywords:

Cerebellopontine angle, magnetic resonance imaging, meningioma susceptibility-weighted imaging, vestibular schwannoma,

PDF

___

Haacke EM, Mittal S, Wu Z, Neelavalli J, Cheng YC. Susceptibility-weighted imaging: Technical aspects and clinical applications, part 1. AJNR Am J Neuroradiol 2009;30:19-30.
Gasparotti R, Pinelli L, Liserre R. New MR sequences in daily practice: Susceptibility weighted imaging. A pictorial essay. Insights Imaging 2011;2:335-47.
Nakamura M, Roser F, Dormiani M, Matthies C, Vorkapic P, Samii M. Facial and cochlear nerve function after surgery of cerebellopontine angle meningiomas. Neurosurgery 2005;57:77-90.
Voss NF, Vrionis FD, Heilman CB, Robertson JH. Meningiomas of the cerebellopontine angle. Surg Neurol 2000;53:439-46.
Lalwani AK, Jackler RK. Preoperative differentiation between meningioma of the cerebellopontine angle and acoustic neuroma using MRI. Otolaryngol Head Neck Surg 1993;109:88-95.
Mikhael MA, Ciric IS, Wolff AP. Differentiation of cerebellopontine angle neuromas and meningiomas with MR imaging. J Comput Assist Tomogr 1985;9:852-6.
Grey PL, Moffat DA, Hardy DG. Surgical results in unusual cerebellopontine angle tumours. Clin Otolaryngol Allied Sci 1996;21:237-43.
Thamburaj K, Radhakrishnan VV, Thomas B, Nair S, Menon G. Intratumoral microhemorrhages on T2*- weighted gradient-echo imaging helps differentiate vestibular schwannoma from meningioma. AJNR Am J Neuroradiol 2008;29:552-7.
Zee CS, Chen T, Hinton DR, Tan M, Segall HD, Apuzzo ML. Magnetic resonance imaging of cystic meningiomas and its surgical implications. Neurosurgery 1995;36:482-8.
Hayman LA, Taber KH, Ford JJ, Bryan RN. Mechanisms of MR signal alteration by acute intracerebral blood: Old concepts and new theories. AJNR Am J Neuroradiol 1991;12:899-907.
Park CK, Kim DC, Park SH, Kim JE, Paek SH, Kim DG, et al. Microhemorrhage, a possible mechanism for cyst formation in vestibular schwannomas. J Neurosurg 2006;105:576-80.
Ishii K, Takahashi S, Matsumoto K, Ishibashi T, Sakamoto K, Hashimoto S, et al. Hemorrhage and abnormal veins in acoustic neurinoma: MR findings. Radiat Med 1996;14:65-9.
Tomogane Y, Mori K, Izumoto S, Kaba K, Ishikura R, Ando K, et al. Usefulness of PRESTO magnetic resonance imaging for the differentiation of schwannoma and meningioma in the cerebellopontine angle. Neurol Med Chir (Tokyo) 2013;53:482-9.
Mubarak F, Tanwir A, Nizamani WM. A rare case of melanotic schwannoma: Utility of susceptibility weighted sequences in preoperative imaging. Cureus 2018;10:e3068.
Mishra A, Thomas B, Kapilamoorthy TR. Susceptibility weighted imaging - a problem-solving tool in differentiation of cerebellopontine angle schwannomas and meningiomas. Neuroradiol J 2017;30:253-8.