A case of atypical meningioma presenting spontaneous infarction: the findings of magnetic resonance imaging, including amide proton transfer-chemical exchange saturation transfer imaging

BJR|Case Reports Pub Date : 2024-07-09 DOI:10.1093/bjrcr/uaae023

E. Iida, Atsuo Inoue, M. Tanabe, Naohiko Kamamura, Katsuyoshi Ito

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Abstract

We report the MRI findings of a patient with an atypical meningioma who presented with spontaneous infarction. A 67-year-old man with histories of recurrent meningioma complained of left ocular protrusion and a subsequent biopsy revealed atypical meningioma. Contrast-enhanced CT showed a uniformly enhancing tumor in the left ethmoid sinus, but MRI 2 days later showed no enhancement on Gd-T1WI and severe diffusion restriction on DWI, indicating spontaneous infarction. APT-CEST imaging showed slight hypointensity in comparison to the normal brain with a mean MTR asymmetry value of 0.48%. Tumor regrowth was confirmed on MRI after 2 months. The recurrent tumor showed moderate diffusion restriction on DWI and hyperintensity with a mean MTR asymmetry value of 2.59% on APT-CEST imaging. The decreased signal on APT-CEST at the time of spontaneous infarction may have been attributed to intratumoral acidosis and loss of viable tumor. APT-CEST imaging is useful for evaluating the intratumoral condition and tumor viability of the infarcted or ischemic tumor.

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一例出现自发性脑梗死的非典型脑膜瘤：磁共振成像（包括酰胺质子转移-化学交换饱和转移成像）的发现

我们报告了一名非典型脑膜瘤患者的磁共振成像结果，该患者出现了自发性脑梗塞。一名有复发性脑膜瘤病史的 67 岁男子主诉左眼球突出，随后的活组织检查发现了非典型脑膜瘤。对比增强 CT 显示左侧乙状窦有均匀增强的肿瘤，但 2 天后的 MRI 显示 Gd-T1WI 没有增强，而 DWI 有严重的弥散受限，表明是自发性梗死。APT-CEST 成像显示，与正常大脑相比，肿瘤密度略低，平均 MTR 不对称值为 0.48%。2 个月后，核磁共振成像证实肿瘤再生。复发肿瘤在 DWI 上显示中度弥散受限，在 APT-CEST 成像上显示高密度，平均 MTR 不对称值为 2.59%。自发性梗死时的 APT-CEST 信号减弱可能是由于瘤内酸中毒和有活力的肿瘤消失所致。APT-CEST 成像有助于评估梗死或缺血肿瘤的瘤内情况和肿瘤存活率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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BJR|Case Reports

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