From the FDA Drug Label
In another multicenter study of 49 evaluable adult patients with known intracranial tumor with high suspicion of having cerebral metastases, two doses of gadoteridol were administered. The results of the non-contrast and contrast MRI scans were compared. Approximately 75-82% of the scans were enhanced, 45-48% of the scans provided additional diagnostic information, and 8-25% of the diagnoses were changed.
Yes, an MRI of the head with or without contrast should be ordered when a meningioma is seen on a CT scan of the head, as it can provide additional diagnostic information and enhance visualization of the lesion. 1 1
From the Research
For a meningioma detected on CT head, you should order an MRI head with and without contrast, as this combination provides the most comprehensive evaluation, allowing for accurate characterization and management planning, as supported by the most recent and highest quality study 2. When a meningioma is seen on a Computed Tomography (CT) scan of the head, ordering a Magnetic Resonance Imaging (MRI) of the head with and without contrast is crucial for several reasons.
- The non-contrast images serve as a baseline, providing valuable information about the tumor's size, location, and relationship to adjacent structures.
- Contrast enhancement is essential as meningiomas typically enhance avidly and uniformly due to their vascular nature and lack of blood-brain barrier.
- Contrast helps delineate the tumor's exact size, location, and relationship to adjacent structures like blood vessels and cranial nerves.
- It also helps distinguish meningiomas from other intracranial masses and detect any dural tail sign, which is characteristic of meningiomas.
- Additionally, contrast-enhanced MRI assists in surgical planning by revealing the tumor's vascularity and potential involvement of critical structures. However, recent studies have suggested that non-contrast MRI may be sufficient for follow-up of untreated meningiomas, with excellent agreement between T1 3D-gadolinium and T2WI segmentations 2.
- This approach could be cost-effective and avert risks associated with contrast media.
- Nevertheless, for initial characterization and management planning, the combination of MRI with and without contrast remains the gold standard, as it provides the most comprehensive evaluation. It's worth noting that other imaging modalities, such as ⁶⁸Ga-DOTATOC PET/CT, may also be useful in certain cases, particularly for detecting meningiomas that are difficult to visualize on MRI 3.
- However, MRI with and without contrast remains the primary imaging modality for evaluating meningiomas, due to its high sensitivity and specificity, as well as its ability to provide detailed information about the tumor's size, location, and relationship to adjacent structures 4, 5, 6.