Transcranial color‐coded sonography may indirectly reveal an intracranial meningioma

Abstract

Meningiomas are extra-axial tumors with a long-standing indolent clinical course.Sphenoid wing meningiomas may slowly grow, spreading toward the orbitofrontal and temporal regions as well as encasing the middle cerebral artery (MCA). Herein, we report the incidental finding of a sphenoid wing meningioma compressing the MCA in a patient who undergone a transcranial sonography study for recurrent speech disorders. We illustrate the associated sonographic "red flags" which should prompt to suspect an underlying compressive space-occupying lesion. K E Y W O R D S brain neoplasm, intracranial arterial stenosis, meningioma

Transcranial ultrasonography imaging of a suprasellar meningioma: A case description and technical notes

“…In the case of an adequate acoustic window, the use of neuroimaging in adults should not be considered limited to the evaluation of intracranial blood flow with transcranial colour Doppler. [3][4][5][6]9 CT and MR imaging represent the radiological studies of choice for evaluating intracranial tumours and the central skull region. Besides suprasellar meningiomas, differential diagnoses for this region include craniopharyngiomas, pituitary macroadenomas, epidermoid cysts, clival chordomas, Rathke's cleft cysts, metastases and giant thrombosed aneurysms.…”

“…Intra-tumoral calcifications are often found in the craniopharyngiomas and meningiomas and can be clearly detected, such as in this case, by ultrasonography. 3,4,6 Nevertheless, CT and MR maintain a crucial role in distinguishing between these possibilities.…”

“…Bartolini et al 6 first reported that, while performing TCCS, unusual cerebral parenchymal texture, aberrant calcifications, acoustic shadowing of the sphenoid lesser wing along with arterial displacement, should be considered "red flags" features prompting to further investigate for an underlying neoplasm, in that case, a meningioma. In the case we describe, a suprasellar meningioma has been directly imaged with a level of accuracy and spatial resolution very similar to that provided by CT: Figure 1 shows that the images obtained with CT and TCCS are really stackable.…”

“…The description of this case, after that of Bartolini et al, 6 aims to sensitise clinicians and neuroradiologists to the opportunity to further explore the full potential of this technology applied to the study of meningiomas. Neurologists and neurosonologists should know the possibility to incidentally find meningiomas or other brain lesions during routinary TCCS vascular imaging, worthy to be addressed to further examinations.…”

“…Most asymptomatic lesions can be managed by surveillance imaging and follow‐up, 2 therefore, the ideal technology should be cheap, non‐invasive, safe and able to reduce radiation exposure. Transcranial colour‐coded duplex sonography (TCCS) has proved to be able to detect space‐occupying lesions, such as tumours, 3,4 pituitary macroadenomas, 5 intracerebral haemorrhage, aneurysms and arteriovenous malformations; recently, the possibility to detect an intracranial meningioma through several indirect “red flags” features have been reported, 6 but the full potential of TCCS to directly image meningiomas remains unexpressed.…”