First AD

Second AD

35-year-old female with prior history of breast carcinoma presented with frontal headaches.


MRI images reveal a well-defined extra-axial lesion located in the left frontal region. The lesion appears hypointense on T1W images and iso to hypointense on T2W images and shows intense homogenous post contrast enhancement (Figures 1-3). There is no perilesional edema. On T2W images a CSF cleft is seen, which confirms the extra-axial nature of the lesion (Figure 2). On post contrast images, another lesion was seen in the parafalcine location which was inconspicous on the plain scans (Figure 4). It showed homogenous enhancement and a dural tail.


Meningiomas are the most common primary non-glial intracranial tumor. Meningiomas mostly affect people in the middle and late decades of life with a strong female predilection (M:F ratio 1:2).

 Multiple meningiomas are also associated with neurofibromatosis and are found in the younger age group of this population.

• Parasagittal or attached to the sagittal sinus (most common location).

• Dura adjacent to the anterior sylvian fissure region.

• Other locations: clivus, the tentorial leaf, and the tentorial free margin.

Usually meningiomas are asymptomatic. Symptoms are most commonly due to mass effect on adjacent structures and they depend on the tumor location.

• Convexity/parasagittal: seizures & hemiparesis.

• Cavernous sinus: cranial nerve deficit(s).


On plain CT meningiomas appear as a hyperdense to isodense mass lesion with areas of calcification (20-25 percent).

 There may be hyperostosis in the adjacent bones. On post contrast scans, they show intense homogenous enhancement. On T1W MR images, the mass appears hypointense while on T2WI the appearance is variable.

 T2W images are ideal for imaging CSF clefts and the vascular flow voids.

 Post contrast scans show homogeneous enhancement with presence of dural tail, which is a non-specific finding.

 On MR spectroscopy there is presence of alanine peak at 1.3-1.5 ppm at short TE.

 On conventional angiography, there is radial appearance with prolonged vascular stain (termed as the mother-in-law sign).


1. Meningioma.  In: Osborne A. Diagnostic Imaging: Brain. 1

 edition. Salt lake City, Utah: Amirsys. 2004.

2. Jayaraman M, Boxerman J. Adult Brain Tumors. In: Atlas S. Magnetic Resonance Imaging of the Brain and Spine. 4

Edition. Lippincott Williams and Wilkins. 2008.

Image IQ: 35-year-old Female with Headaches

Amar Udare, MD