Meningioma

Findings:
Strongly enhancing cavernous sinus mass, hypo T2, iso T1.

Differential Diagnosis:
meningioma, neuroma, pituitary adenoma, met, lymphoma, aneurysm

Discussion:
distinguishing features: lens shaped/plaquelike appearance, hypo T2

meningiomas typically hypo T2 due to fibrous content or calcification, strongly enhance, iso noncon T1. broad dural base, extraaxial, +/- dural tail. common locations convexity, interhemispheric, tent. Classically iso to GM on all sequences.
   -most common extraaxial neoplasm of adults
   -15% of primary intracranial neoplasms, peak 50-60, F 2:1 intracranial,  4:1 intraspinal
   -25% of intraspinal neoplasms
   -etiology unknown- ?trauma, radiation, virus, familial
   -origin=arachnoid cap cell, possible assn with chr 22 deletion (9%- MISME)
   -hormonally sensitive- pregnancy increases size
   -malignant/aggressive more common in peds (imaging can't distinguish)
   -globular or en plaque
   -x ray: hyperostosis of inner table, enlarged MMAs, Ca++, sinus expansion
   -CT: hyperdense, variable edema (possibly extensive), intense enhancement
   -dural tail (60%)-nonspecific, +/-cysts, +/- fat
   -vascular supply: ECA 85%, ICA 63% -mother in law sign- comes early, stays late

Grading WHO 1993
    mening I
    atypical mening II
    papillary, HPC, anaplastic II-III

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