Article Figures & Data
Figures
- Fig 1.
Patient 1. This large right temporal meningioma was treated via embolization of the right middle meningeal artery. Perfusion MR images and x-ray angiograms are shown before (A–E) and after (F–H) embolization. The baseline MR perfusion image (A) reveals the tumor before administration of contrast. Difference images between this baseline and peak signal intensity attenuation after IV (E), IA CCA (B, F), and IA ECA (C, G) contrast injection are also shown. The ECA injection images reveal the portion of the tumor fed by this vessel before (C) and after (G) embolization. The x-ray angiograms were obtained with an ECA injection and revealed characteristic tumor blush (arrow) originating from the middle meningeal artery. The delivery of embolic agents through this vessel successfully obliterated this portion of the tumor vascular supply, which can be appreciated with both MR (G) and x-ray (H).
- Fig 2.
Patient 2. A large meningioma in the posterior fossa is evident on precontrast MR perfusion (A). Difference images between this baseline and peak signal intensity attenuation after IV (D) and IA right vertebral (B) contrast injection are shown. Selective x-ray angiograms obtained during a right vertebral injection reveal the pattern of the tumor (C). Embolization was administered more distally to this injection site (right posterior meningeal), and obliteration of the posterior component of the right vertebral distribution territory can be appreciated on the MR (E) and x-ray (F) images after embolization.
- Fig 3.
Patient 3. The figure summarizes the effects of embolization of a large right frontal meningioma. The upper row depicts the lesion before embolization and includes a precontrast perfusion source image (A), perfusion difference images between baseline and peak enhancement after right CCA (B) and ECA (C) injection, and a lateral view x-ray angiogram with a right ECA injection (D). Preembolization peak perfusion contrast after IV contrast administration is revealed (E). After embolization, the CCA (F) and ECA (G) perfusion studies and lateral view x-ray angiogram with a right ECA injection were repeated. Contrast injection into the right ECA demonstrates some residual attenuation (G) but is substantially reduced compared with the baseline state. The blush pattern in the proximity of the lesion that was evident on x-ray angiograms is no longer appreciable after treatment (H).
Tables
Tumor Volume R-CCA (%) R-ECA (%) Other (%) Patient 1 X-ray 161 cm3 100 15 0 MR-pre 100 29 – MR-post 77 0 – Patient 2 R-Vert (%) L-Vert (%) Other (%) X-ray 212 cm3 50* 30 20 MR-pre 83 – – MR-post 33 – – Patient 3 R-CCA (%) R-ECA (%) Other (%) X-ray 92 cm3 90 75 10 MR-pre 80 45 – MR-post 58 14 – Patient 4 L-CCA (%) L-ECA (%) Other (%) X-ray 125 cm3† 90 90 10 MR-pre 54 54 – MR-post 0 0 – Note:—R-CCA indicates right common carotid artery; R-ECA, right external carotid artery; L-CCA, left common carotid artery; L-ECA, left external carotid artery; R-Vert, right vertebral artery; L-Vert, left vertebral artery.
* Complete obliteration of this vessel's territory was not attempted.
† MR signal void existed in 87% of this tumor; MR data are percentages of visible portion.
Patient rCBV (% WM) MTT (s) Whole ICA ECA Whole ICA ECA 1-pre 161 990 1060 13.4 11.2 12.1 1-post 930 0 8.5 NA 2-pre 560 620* – 10.0 10.4* – 2-post 850* – 18.2* – 3-pre 1590 640 510 14.6 9.2 9.6 3-post 1170 860 9.0 12.1 Note:—rCBV indicates relative cerebral blood volume; ICA, internal carotid artery; ECA, external carotid artery; MTT, mean transit time; WM, white matter.
* Data from ipsilateral vertebral artery.
