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Imaging approaches for radiosurgical treatment of meningiomas

Stereotactic Radiosurgery for the Treatment of Central Nervous System Meningiomas, Page: 21-25
2021
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Book Chapter Description

Magnetic resonance imaging is the reference standard for targeting lesions in radiosurgery. Computerized tomography is mandatory in systems based on linear accelerators and a useful adjunct in selected cases in gamma beam-based systems. Image registration can help implement information from different imaging systems but must be managed with care acknowledging its intrinsic limits and dangers that may differ in different systems and software versions. Advanced magnetic resonance imaging techniques and PET are some of the tools that can provide important additional data. Meningiomas situated in specific locations pose some diagnostic challenges that must be overcome with tailored sequences. Among those, fat-suppressed sequences are very useful in the study of basicranial and intraorbital meningiomas. Heavily T2-weighted volumetric imaging is very useful to delineate margins of meningiomas in the cavernous sinus or anterior posterior fossa. Atypical meningiomas represent a challenge both from a treatment strategy and diagnostic point of view. Several advanced imaging techniques have been used to identify atypical lesions in the preoperative phase, but up to date no single technique or specific combination of techniques can provide a precise non-invasive diagnosis. Characteristics of meningiomas most commonly associated with malignant composition are summarized.

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