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Intraventricular Meningioma

Gregory D N Pearson, MD, PhD
Roman Klufas, MD

May 16, 1996

Presentation

A 62-year-old woman with a history of psychiatric disorders presented with confusion.

Imaging Findings

CT of the head
T1-weighted MRI of the head
Proton density MRI of the head
T2-weighted MRI of the head
T1-weighted MRI of head after gadolinium injection

Computed tomography (CT) of the head demonstrates mild dilatation of the lateral ventricles, with a 2.5 cm high-attenuation mass (white arrow) in the trigone of the left lateral ventricle. Calcific density (black arrow) in the center may be within the mass or enveloped choroid plexus calcification.

On magnetic resonance imaging (MRI), the lesion is relatively isointense to gray matter on sagittal T1-weighted, axial proton density, and axial T2-weighted images. It shows intense, homogeneous enhancement on a coronal T1-weighted image after gadolinium injection (arrows).

Differential Diagnosis

Imaging characteristics are typical of a meningioma. Other intraventricular tumors include choroid plexus papilloma, which are more commonly found in the fourth ventricle in adults; ependymoma, also more common in the 4th ventricle and in children; and metastasis.

Diagnosis

Intraventricular meningioma

Discussion

Meningiomas comprise 15-18% of intracranial tumors in adults and 33% of all incidental intracranial neoplasms. An intraventricular location is relatively rare, accounting for only 2 % of meningiomas, with 80% of these in the lateral ventricles. Despite this, intraventricular meningioma is the most common trigonal mass in the adult. They are thought to form via the infolding of meningeal tissue during the formation of the choroid plexus. Nonenhanced CT typically demonstrates an iso- to hyperdense lesion. Calcification is seen in 20% of cases, with a psammomatous pattern (diffuse, sand-like appearance) most common. Circular, globular, or radial calcification may also be seen. Hemorrhage is uncommon. On MRI, lesions are typically hypo- to isointense on T1-weighted images and iso- to hyperintense on T2-weighted images. Lesions classically show intense uniform enhancement on both CT and MR images after injection of contrast media due to their lack of blood-brain barrier.

References

1. Dahnert W. Radiology review manual. 2nd ed. Baltimore: Williams and Wilkins, 191-192.

2. Osborn AG. Diagnostic neuroradiology. St. Louis: Mosby, 584-600.

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