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MENINGIOMA
Authored By: Keith Fischer and Shane Inoue.
Patient: 60 year old female
History: 60-year-old female with right breast ductal carcinoma in situ who is status post lumpectomy and radiation.
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CT

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T1 post-contrast
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Findings: Increased activity on the delayed bone scan images in the right parietal region with central photopenia, This almost certainly is not a metastatic lesion. Recommend CT for further evaluation.

Follow-up CT: 4.7 x 3.6 cm partially calcified mass in the right parietal region most compatible with a meningioma arising from the posterior falx, corresponding to the lesion seen on bone scintigraphy. MRI the brain is recommended for further evaluation.

Follow-up MR: Right extra-axial parietal mass, that demonstrates brisk enhancement, and a paucity of adjacent brain edema. The lesion demonstrates demonstrates areas of T2 star susceptibility consistent with calcification.  Calcifications were also noted on the prior computed tomography examination. These findings are most consistent with a meningioma.
DDx: DDx for solitary brain lesions on bone scintigraphy:

Infarction with dystrophic calcification
Calcification (meningial calcification)
Tumors
Diagnosis: Meningioma
General Discussion: Tc-99m-MDP is known to accumulate in meningiomas.  The cause of this has been speculated to be tumor calcification, calvarial erosion, and/or the formation of reactive bone.

In 1985, Shih, et. al presented a patient with a frontal meningioma that was evaluated using 99mTc-methylene-diphosphonate bone scintigraphy, head computed tomography, and skull radiography; the homogeneous density seen in the radiographic studies corresponded to the area of bone-seeking-agent localization shown in the scintigram. At autopsy, bony tissue and a few psammoma bodies were found in the meningioma, and apparently accounted for the bone-tracer localization. There was no calvarial erosion and no formation of reactive bone (Shih, et al., 2008).
References: Thank you to Dr. Asif Moinuddin for contributing this case.

Eur J Nuc Med (1985) 11:43-45
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Additional Details:

Case Number: 123553Owner(s): Keith Fischer and Shane InoueLast Updated: 02-07-2013
Anatomy: Cranium and Contents   Pathology: Neoplasm
Modality: CT, MR, Nuc MedAccess Level: Readable by all users, writable by NucMed Certifiers
Keywords: meningioma

Case has been viewed 27 times.
Certified by Keith Fischer on 06-26-2009

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