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Spinal canal meningioma mimicking posterior fossa ischemia on CT perfusion: A CT perfusion pitfall.

ABSTRACT: The recent approach to treat acute stroke is to extend treatment window in patients with salvageable peri-infarct ischemia which increases the application of the perfusion imaging, specifically computed tomography perfusion (CTP). In this paper, I am presenting a case of left middle cerebral artery infarction which was evaluated by CTP under "code stroke." The patient had an incidental spinal canal meningioma which was out of field of view in CTP but mimicked right cerebellar ischemia on CTP. Although ischemia has been previously reported within the peripheral parenchymal edema surrounding a meningioma, in this patient there was no evidence of edema in the right cerebellum on magnetic resonance imaging. I believe the CTP findings are secondary to steal phenomena at right vertebral artery or compression upon the venous plexus. Recently, by using modern computed tomography scanners, it is common to cover the entire brain in CTP. The emergency radiologist should be aware of this pitfall that spinal canal pathologies which are out of field of view can mimic posterior fossa ischemia.

SUBMITTER: Sotoudeh H

PROVIDER: S-EPMC6137824 | biostudies-other | 2018 Oct

REPOSITORIES: biostudies-other

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Spinal canal meningioma mimicking posterior fossa ischemia on CT perfusion: A CT perfusion pitfall.

Sotoudeh Houman H

Radiology case reports 20180601 5

The recent approach to treat acute stroke is to extend treatment window in patients with salvageable peri-infarct ischemia which increases the application of the perfusion imaging, specifically computed tomography perfusion (CTP). In this paper, I am presenting a case of left middle cerebral artery infarction which was evaluated by CTP under "code stroke." The patient had an incidental spinal canal meningioma which was out of field of view in CTP but mimicked right cerebellar ischemia on CTP. Al ...[more]

PMID: 30228845

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Project description:Background and purposePediatric posterior fossa tumors often present with hydrocephalus; postoperatively, up to 25% of patients develop cerebellar mutism syndrome. Arterial spin-labeling is a noninvasive means of quantifying CBF and bolus arrival time. The aim of this study was to investigate how changes in perfusion metrics in children with posterior fossa tumors are modulated by cerebellar mutism syndrome and hydrocephalus requiring pre-resection CSF diversion.Materials and methodsForty-four patients were prospectively scanned at 3 time points (preoperatively, postoperatively, and at 3-month follow-up) with single- and multi-inflow time arterial spin-labeling sequences. Regional analyses of CBF and bolus arrival time were conducted using coregistered anatomic parcellations. ANOVA and multivariable, linear mixed-effects modeling analysis approaches were used. The study was registered at clinicaltrials.gov (NCT03471026).ResultsCBF increased after tumor resection and at follow-up scanning (P = .045). Bolus arrival time decreased after tumor resection and at follow-up scanning (P = .018). Bolus arrival time was prolonged (P = .058) following the midline approach, compared with cerebellar hemispheric surgical approaches to posterior fossa tumors. Multivariable linear mixed-effects modeling showed that regional perfusion changes were more pronounced in the 6 children who presented with symptomatic obstructive hydrocephalus requiring pre-resection CSF diversion, with hydrocephalus lowering the baseline mean CBF by 20.5 (standard error, 6.27) mL/100g/min. Children diagnosed with cerebellar mutism syndrome (8/44, 18.2%) had significantly higher CBF at follow-up imaging than those who were not (P = .040), but no differences in pre- or postoperative perfusion parameters were seen.ConclusionsMulti-inflow time arterial spin-labeling shows promise as a noninvasive tool to evaluate cerebral perfusion in the setting of pediatric obstructive hydrocephalus and demonstrates increased CBF following resolution of cerebellar mutism syndrome.

Dataset Information

Spinal canal meningioma mimicking posterior fossa ischemia on CT perfusion: A CT perfusion pitfall.

Publications

Spinal canal meningioma mimicking posterior fossa ischemia on CT perfusion: A CT perfusion pitfall.

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