Advanced and Modern Imaging Techniques for the Evaluation of Intracranial Meningiomas

Abstract

Intracranial meningiomas are the most common primary extra-axial brain tumours. These tumours constitute a considerable percentage of brain tumours occurring in adults. Although the majority of meningiomas are benign tumours, some exhibit aggressive features. These tumours have complex relationships with adjacent structures. Hence, precise investigation and treatment planning are essential. Advanced and modern imaging techniques have an important role to play in the comprehensive investigation of these tumours, which is beyond the capabilities of traditional and conventional imaging techniques. The gold standard method for examining and assessing intracranial meningiomas prior to surgery is magnetic resonance imaging (MRI). Recent advances in MRI techniques, including diffusion tensor imaging (DTI), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), perfusion-weighted imaging (PWI) and susceptibility-weighted imaging (SWI) provide useful information regarding the tumour. Computed Tomography (CT), especially when performed with bone window images, continues to be useful in the assessment of calcifications and hyperostosis. The new imaging modalities such as Positron Emission Tomography (PET), Hybrid PET-MRI systems, and the application of radiomics in imaging further help in improving the accuracy of the imaging studies and in developing patient-specific management protocols. Functional imaging techniques are increasingly being employed in the preoperative planning of neurosurgical interventions, especially in the case of lesions adjacent to eloquent areas. The limitations of advanced and modern imaging modalities in the evaluation of intracranial meningiomas. The emphasis has been placed on the role of imaging in the diagnosis, grading, preoperative planning, treatment monitoring, and prognostication of meningiomas. The integration of the multiparametric imaging techniques has become essential in achieving the best possible outcome in the neuro-oncological patient.