MAGNETIC RESONANCE IMAGING FEATURES OF CERVICAL SPINAL CORD MENINGIOMAS

The records of four dogs with cervical spinal cord meningiomas were retrospectively reviewed. Signalment, history, laboratory findings, neurological examination, and histopathological findings were evaluated. Magnetic resonance imaging (MRI) was performed using a 1.0-T superconducting magnet and T2-weighted (W) and noncontrast and postcontrast T1-W spin echo pulse sequences. Meningiomas were located at the level of the second, third, and fifth cervical vertebrae and the C2-3 intervertebral space. All meningiomas appeared as focal masses that were hyperintense to the spinal cord on T2-W images and iso- to hypointense on the T1-W images. They could be identified as intradural and extramedullary in origin based on a broad-based dural margin seen on at least one of the imaging planes and a gradual expansion of the subarachnoid space cranial and caudal to the mass, best noted on the transverse and dorsal plane images. On dorsal plane T2-W images in three dogs, expansion of the subarachnoid space adjacent to the mass appeared similar to the myelographic "golf tee" sign. All meningiomas exhibited moderate, well-defined contrast enhancement with dural tails seen in three of the four dogs. One dog had extension into the intervertebral foramen along the nerve and ipsilateral atrophy of the muscles of the neck. By differentiating the meningiomas from intramedullary tumors and by clearly depicting the extent of the masses, MRI provided valuable information about treatment options and prognosis.     

A Surgical Approach to the Canine Olfactory Bulb for Meningioma Removal

Olfactory bulb lesions were diagnosed in four dogs presented for generalized seizure disorders. Surgery was performed on each dog using a transfrontal craniotomy. A free fascial-fat graft was used to cover the dural defect resulting from surgery. No major complications were observed during the immediate postoperative period. The histopathologic diagnosis in each case was meningioma. Generalized seizures recurred in all dogs, and three dogs were euthanized for this reason from 9 to 29 weeks postoperatively. One dog was euthanized 12 weeks after surgery due to pancreatitis and pneumonia. Necropsy showed that two dogs had recurrent olfactory bulb meningiomas, one dog had a meningioma of the opposite olfactory bulb, and one dog was tumor free.     

MENINGEAL ENHANCEMENT ON MAGNETIC RESONANCE IMAGING IN 15 DOGS AND 3 CATS

A retrospective study of 15 dogs and three cats was done to characterize the appearance of meningeal enhancement on magnetic resonance (MR) images of the brain, and to correlate this appearance with its underlying cause. Two patterns of meningeal enhancement (pial and dural) were identified. Enhancement of the pia mater was evident in four dogs and one cat, while enhancement of the dura mater was seen in 11 dogs and 2 cats. A variety of causes of meningeal enhancement were identified, including bacterial and cryptococcal meningitis, plasmacytic meningitis with associated subdural fluid accumulation, granulomatous meningoencephalomyelitis, inflammation secondary to otitis interna, feline infectious peritonitis, and neoplasia. The present study confirms that pial or dural meningeal enhancement may be present on MR images of the brain of dogs or cats in association with a variety of central nervous system diseases. A larger prospective study is required to further establish the incidence of specific patterns of meningeal enhancement seen in association with specific diseases.     

MR IMAGING OF HISTIOCYTIC SARCOMA OF THE CANINE BRAIN

Histiocytic sarcomas are characterized by proliferation and/or infiltration of neoplastic histiocytes localized to specific organs, unlike malignant histiocytosis which involves many organ systems. Only a few cranial histiocytic sarcomas have been reported. Here we describe four dogs that presented with neurological deficits referable to the forebrain, and were diagnosed histologically as having histiocytic sarcoma. Using magnetic resonance (MR) imaging, the tumors were characterized by a T2-hyperintense and T1-isointense mass in one dog, T2- and T1-isointense extraaxial masses in two dogs, and a diffuse T2-hyperintense lesion over the left cerebral cortex in one dog. All tumors had contrast enhancement. MRI features in three of the four dogs were similar to that of meningioma, supported by the observation of a dural tail in two of these three dogs, and a broad base of attachment in the other. In the other dog the imaging findings were similar to those of encephalitis. Intracranial histiocytic sarcoma does not appear to have specific MR imaging features and can be confused with meningioma or encephalitis.     

UTILITY OF MAGNETIC RESONANCE IMAGING FOR DISTINGUISHING NEOPLASTIC FROM NON-NEOPLASTIC BRAIN LESIONS IN DOGS AND CATS

The aim of this study was to identify magnetic resonance (MR) signs that aid differentiation of neoplastic vs. non-neoplastic brain diseases in dogs and cats. MR images of 36 dogs and 13 cats with histologic diagnosis of intracranial disease were reviewed retrospectively. Diagnoses included 30 primary and three metastatic brain tumors, 11 infectious/inflammatory lesions, three vascular, one degenerative disease, and one developmental malformation. Upon univariate analysis of 21 MR signs, there were seven that had a significant association with neoplasia: single lesion (P = 0.004), shape (P = 0.015), mass effect (P = 0.002), dural contact (P = 0.04), dural tail (P = 0.005), lesions affecting adjacent bone (P = 0.008), and contrast enhancement (P = 0.025). Increasing age was also found to be associated with neoplasia (P = 0.0001). MR signs of non-neoplastic brain diseases in dogs and cats were more variable than those of brain neoplasia.     

Evaluation of progesterone and estrogen receptor expression in 15 meningiomas of dogs and cats

OBJECTIVE: To evaluate progesterone and estrogen receptor expression in meningiomas of the CNS in dogs and cats. ANIMAL: 8 dogs (1 of which was treated with gestrinone) and 5 cats with intracranial meningiomas and 2 dogs with spinal cord meningiomas; tissue samples were also obtained from 1 clinically normal dog and 1 clinically normal cat. PROCEDURE: Meningioma tissue was obtained during surgery or at necropsy; samples were processed for histologic classification and immunohistochemical evaluation of the proportion of tumor cells with progesterone and estrogen receptors. Correlation among receptor expression, tumor grade, and histologic subtypes was determined. RESULT: Several histologic subtypes of intracranial meningiomas were detected among tissue samples. In the cats, all intracranial meningiomas were benign. Progesterone receptor immunoreactivity was detected in 14 of 15 meningiomas. Progesterone receptor expression was identified in > 80% of cells in 8 intracranial meningiomas (4 dogs and 4 cats) and 2 spinal cord meningiomas. In samples of malignant transitional and granular cell meningiomas in dogs, progesterone receptors were detected in 32 and 4.8% of cells respectively. In 1 cat, 38% of tumor cells had progesterone receptors. In a dog treated with gestrinone, no progesterone receptors were detected in the intracranial meningioma. Estrogen receptors were only detected in the tumor of 1 dog. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicate a high proportion of progesterone receptors in cells of meningiomas of the CNS in dogs and cats. Antiprogesterone treatment may have a role in the treatment of unresectable or recurrent meningiomas in dogs and cats.     

A meningioma with hyperintensity on T1-weighted images in a dog

A male six-year-old Pomeranian showed recurrent seizures and progressive left hemiparesis. MRI revealed a mass in the right paramedian frontal-temporal region with hyperintensity on T1-weighted (T1W) and mixed-intensity on T2-weighted (T2W) images. After gadolinium enhancement, the mass was enhanced homogenously and demonstrated the dural tail sign. Surgical resection of mass was performed and its histological diagnosis was meningioma. The meningioma of this case had a high cellular density with some lipid contents and intra- and extra-tumor hemorrhage, however, calcification was not found. These cellular characteristics may contribute to a higher signal intensity on T1W imaging.     

IMAGING DIAGNOSIS—MAGNETIC RESONANCE IMAGING OF DIFFUSE LEPTOMENINGEAL OLIGODENDROGLIOMATOSIS IN A DOG WITH “DURAL TAIL SIGN”

A case of diffuse leptomeningeal oligodendrogliomatosis affecting the brain and spinal cord of a dog is presented. A 7.5‐year old, male neutered Staffordshire bull terrier presented for evaluation of a chronic history of tetraparesis and seizures, with a multifocal neuroanatomical localization was determined. Extra‐axial intradural lesions with an atypical presentation of a dural tail sign were seen on MRI. Histologically, the lesions were consistent with leptomeningeal oligodendrogliomatosis. To the authors’ knowledge, a dural tail sign has not previously been reported as an MRI characteristic of diffuse leptomeningeal oligodendrogliomatosis in dogs.     

Multiple meningiomas: clinical, radiological, surgical, and pathological findings with outcome in four cats

The present report describes the clinical signs, magnetic resonance imaging (MRI) findings, surgical procedure, pathological findings and follow-up in four cats with multiple meningiomas; three castrated male and one spayed female domestic shorthair indoor cats, ranging in age from 11 to 14 years. In three of four cats, clinical signs at presentation were suggestive of a focal lesion. Three cats had two meningiomas and one had four meningiomas. Most of the tumours were supratentorial, one arose from the tentorium and one was infratentorial. The duration of presenting signs before surgery ranged from 10 days to 11 months. Postoperative MRI revealed complete gross tumour removal in three cases. In one cat with two cranial fossa meningiomas, subtotal excision with a small basal remnant (2 x 2 mm) of the ventral part of one meningioma lying on the floor of the skull, was observed. Based on histopathological architecture, six tumours revealed features of a transitional subtype meningioma, and four of a meningotheliomatous meningioma. In each cat, the multiple meningiomas were all assigned to the same histopathological group. The preoperative presenting signs had resolved by the follow-up examinations 4 weeks after surgery in two cats. Long-term follow-up evaluation revealed that surgically-induced or exacerbated neurological deficits in two cats had completely or almost completely resolved within 8 weeks of surgery. All patients are still alive 12 to 21 months after surgery and no clinical signs of recurrence could be detected at that time.     

Canine intraspinal meningiomas: imaging features, histopathologic classification, and long-term outcome in 34 dogs

BACKGROUND: Meningioma is the most common primary intraspinal nervous system tumor in dogs. Clinical findings, clinicopathologic data, and treatment of these tumors have been reported sporadically, but little information is available regarding cerebrospinal fluid (CSF) analysis, histologic tumor grade, or efficacy of radiation therapy as an adjunct to cytoreductive surgery. ANIMALS: Dogs with histologically confirmed intraspinal meningiomas (n = 34). METHODS: A retrospective study of dogs with intraspinal meningiomas between 1984 and 2006 was carried out. Signalment, historical information, physical examination, clinicopathologic data, radiation therapy protocols, surgery reports, and all available images were reviewed. All tumors were histologically classified and graded as defined by the international World Health Organization classification scheme for central nervous system tumors. RESULTS: Intraspinal mengiomas in dogs are most common in the cervical spinal cord but can be found throughout the neuraxis. Location is correlated with histologic grade, with grade I tumors more likely to be in the cervical region than grade II tumors. Myelography generally shows an intradural extramedullary compressive lesion. On magnetic resonance imaging, the masses are strongly and uniformly contrast enhancing and a dural tail often is present. CSF analysis usually shows increased protein concentration with mild to moderate mixed pleocytosis. Surgical resection is an effective means of improving neurologic status, and adjunctive radiation therapy may lead to an improved outcome. CONCLUSIONS AND CLINICAL IMPORTANCE: Biopsy is necessary for definitive diagnosis, but imaging and CSF analysis can suggest a diagnosis of meningioma. Treatment of meningiomas with surgery and radiation therapy can result in a fair to excellent prognosis.     

USE OF THE T2*‐WEIGHTED GRADIENT RECALLED ECHO SEQUENCE FOR MAGNETIC RESONANCE IMAGING OF THE CANINE AND FELINE BRAIN

T2*‐weighted magnetic resonance imaging (MRI) has been reported to help improve detection of intracranial hemorrhage and is widely used in human neuroimaging. To assess the utility of this technique in small animals, interpretations based on this sequence were compared with those based on paired T2‐weighted and fluid‐attenuated inversion recovery (FLAIR) sequences in 200 dogs and cats that underwent brain MRI for suspected intracranial disease. Two sets of images (T2 + FLAIR and T2*) were reviewed separately in random order unaccompanied by patient information and were interpreted as normal or abnormal based on whether intracranial abnormalities were seen. The number and location of intracranial lesions were recorded. Eighty‐five studies were considered normal and 88 were considered abnormal based on both sets of images, with good agreement (κ = 0.731) between the two. Susceptibility artifact was present in 33 cases (16.5%) on T2*‐weighted images. In 12 cases (6%) a total of 69 lesions were seen on T2*‐weighted images that were not seen on T2/FLAIR, all of which were associated with susceptibility artifact caused by presumed intracranial hemorrhage. Pseudolesions were seen on T2*‐weighted images in five cases, none of which were associated with susceptibility artifact. Abnormalities were seen on T2/FLAIR images that were not seen on T2*‐weighted images in 35 cases, confirming that T2* does not replace standard spin echo sequences. These results support inclusion of T2*‐weighted sequences in small animal brain MRI studies and indicate that that a large number of abnormalities (especially hemorrhagic lesions) can go undetected if it is not performed.     

Intracranial meningioma: a comparative pathologic study of 28 dogs

Intracranial meningiomas were identified in 28 dogs based on histologic examination of tissue. The average age of the dogs was 11 years, and 83% (20/24) were 10 years old or older. German shepherd and mixed breed were most common (31% each, 8/26). Grossly, meningiomas were oval, dome-shaped and flattened masses adherent to the dura and compressing the brain. Forty-eight percent (15/26) of the tumors affected the dorsal surface of the brain, and two thirds of these were located in the anterior half. Histologically, tumor types were transitional (13), meningotheliomatous (11), angioblastic (three), and fibroblastic (one). There was direct invasion of the brain in 27% (6/22) although we observed neurologic signs and pathologic changes in 88% (23/26) and 90% (18/20) of the dogs, respectively. Intracranial meningioma can be compared and contrasted with this tumor in man and cats.     

Paranasal meningioma in the dog: a clinicopathologic study of ten cases

Paranasal meningiomas were diagnosed in ten dogs based on gross and light microscopic examinations of tissue specimens, and, in one case, electron microscopic examination. Seven of ten dogs were female (average age was 13 years). Most dogs (7/10) had seizures on examination. Two dogs with meningioma located in the nasal cavity had nasal discharge, and one had epistaxis. Tumors originated in the nasoparanasal region (eight) and frontal region of the cranial cavity (two). The histologic types of meningioma included psammomatous (two), transitional (three), meningotheliomatous (two), fibroblastic (two), and angioblastic (one). Tumors were malignant and extended to the brain in eight cases. These tumors differed from intracranial meningiomas mainly in their more anaplastic nature and aggressive behavior.     

APPEARANCE OF THE CANINE MENINGES IN SUBTRACTION MAGNETIC RESONANCE IMAGES

The canine meninges are not visible as discrete structures in noncontrast magnetic resonance (MR) images, and are incompletely visualized in T1‐weighted, postgadolinium images, reportedly appearing as short, thin curvilinear segments with minimal enhancement. Subtraction imaging facilitates detection of enhancement of tissues, hence may increase the conspicuity of meninges. The aim of the present study was to describe qualitatively the appearance of canine meninges in subtraction MR images obtained using a dynamic technique. Images were reviewed of 10 consecutive dogs that had dynamic pre‐ and postgadolinium T1W imaging of the brain that was interpreted as normal, and had normal cerebrospinal fluid. Image‐anatomic correlation was facilitated by dissection and histologic examination of two canine cadavers. Meningeal enhancement was relatively inconspicuous in postgadolinium T1‐weighted images, but was clearly visible in subtraction images of all dogs. Enhancement was visible as faint, small‐rounded foci compatible with vessels seen end on within the sulci, a series of larger rounded foci compatible with vessels of variable caliber on the dorsal aspect of the cerebral cortex, and a continuous thin zone of moderate enhancement around the brain. Superimposition of color‐encoded subtraction images on pregadolinium T1‐ and T2‐weighted images facilitated localization of the origin of enhancement, which appeared to be predominantly dural, with relatively few leptomeningeal structures visible. Dynamic subtraction MR imaging should be considered for inclusion in clinical brain MR protocols because of the possibility that its use may increase sensitivity for lesions affecting the meninges.     

Acute postretinal blindness: ophthalmologic,neurologic, and magnetic resonance imaging findings in dogs and cats (seven cases)

Objective To describe the ophthalmologic, neurologic, and magnetic resonance imaging (MRI) findings of seven animals with acute postretinal blindness as sole neurologic deficit. Methods Medical records were reviewed to identify dogs and cats with postretinal blindness of acute presentation, that had a cranial MRI performed as part of the diagnostic workup. Only animals lacking other neurologic signs at presentation were included. Complete physical, ophthalmic, and neurologic examinations, routine laboratory evaluations, thoracic radiographs, abdominal ultrasound, electroretinography, and brain MRI were performed in all animals. Cerebrospinal fluid analysis and postmortem histopathologic results were recorded when available. Results Four dogs and three cats met the inclusion criteria. Lesions affecting the visual pathways were observed on magnetic resonance (MR) images in six cases. Location, extension, and MRI features were described. Neuroanatomic localization included: olfactory region with involvement of the optic chiasm (n = 4), pituitary fossa with involvement of the optic chiasm and optic tracts (n = 1), and optic nerves (n = 1). Of all lesions detected, five were consistent with intracranial tumors (two meningiomas, one pituitary tumor, two nasal tumors with intracranial extension), and one with bilateral optic neuritis that was confirmed by cerebrospinal fluid analysis. Histologic diagnosis was obtained in four cases and included one meningioma, one pituitary carcinoma, one nasal osteosarcoma, and one nasal carcinoma. Conclusions Central nervous system (CNS) disease should be considered in dogs and cats with acute blindness, even when other neurologic deficits are absent. This study emphasizes the relevance of MRI as a diagnostic tool for detection and characterization of CNS lesions affecting the visual pathways.     

Definitive‐intent intensity‐modulated radiation therapy provides similar outcomes to those previously published for definitive‐intent three‐dimensional conformal radiation therapy in dogs with primary brain tumors: A multi‐institutional retrospective study

Radiotherapy with or without surgery is a common choice for brain tumors in dogs. Although numerous studies have evaluated use of three‐dimensional conformal radiotherapy, reports of definitive‐intent, IMRT for canine intracranial tumors are lacking. Intensity‐modulated radiation therapy has the benefit of decreasing dose to nearby organs at risk and may aid in reducing toxicity. However, increasing dose conformity with IMRT calls for accurate target delineation and daily patient positioning, in order to decrease the risk of a geographic miss. To determine survival outcome and toxicity, we performed a multi‐institutional retrospective observational study evaluating dogs with brain tumors treated with IMRT. Fifty‐two dogs treated with fractionated, definitive‐intent IMRT at four academic radiotherapy facilities were included. All dogs presented with neurologic signs and were diagnosed via MRI. Presumed radiological diagnoses included 37 meningiomas, 12 gliomas, and one peripheral nerve sheath tumor. One dog had two presumed meningiomas and one dog had either a glioma or meningioma. All dogs were treated in the macroscopic disease setting and were prescribed a total dose of 45‐50 Gy (2.25‐2.5 Gy per fraction in 18‐20 daily fractions). Median survival time for all patients, including seven cases treated with a second course of therapy was 18.1 months (95% confidence of interval 12.3‐26.6 months). As previously described for brain tumors, increasing severity of neurologic signs at diagnosis was associated with a worse outcome. Intensity‐modulated radiation therapy was well tolerated with few reported acute, acute delayed, or late side effects.     

Microcystic meningioma of the fourth ventricle in a dog

A 5-year-old female cross-breed dog was presented with a 1-month history of progressive changes in the posture of the head and in the gait. At neurological examination the dog showed a central vestibular syndrome lateralized to the left. MRI showed a space occupying lesion within the fourth ventricle, characterized by iso- to hypointensity in T1 and hyperintensity in T2 with a heterogeneous contrast uptake. Histologically, a neoplasia composed of meningothelial cells forming compact whorls with slight atypia, and stellate cells delimitating microcysts containing eosinophilic fluid was observed. Neoplastic cells were positive for vimentin and negative for GFAP and FVIII. A diagnosis of intraventricular microcystic meningioma was achieved. Intraventricular meningiomas in dogs are rarely encountered and reports of meningiomas within the fourth ventricle have not yet been described. Although choroid plexus tumor is the most frequent neoplasia localized in the fourth ventricle, intraventricular meningioma should be included in the differential diagnoses.     

Evaluation of craniotomy in dogs and cats

Over a reporting period of 5 years, craniotomy was performed in 26 dogs and 5 cats with various intracranial lesions. X-ray computed tomography was performed in all animals prior to surgery. Twenty dogs and all cats had intracranial neoplasms; of these, 14 were meningioma, and 11 represented a wide variety of brain tumors and skeletal tumors. Three dogs were treated surgically for traumatic, open-skull fractures with cerebral damage, and 3 underwent biopsy to evaluate chronic inflammatory brain disease. The overall medium survival time was 212 days, the 1-year survival rate was 39%, and the 2-year survival rate was 20%. Dogs and cats with meningioma survived a mean 198 and 485 days, respectively, with 1-year survival rates of 30% for dogs and 50% for cats. The overall median survival time for animals with tumors other than meningeal intracranial neoplasms was 414 days, with a 1-year survival rate of 40%. The death of 19% of all animals could be related to the combination of advanced brain disease and surgery. Because fatality seldom occurred as a direct result of surgery, morbidity and mortality associated with craniotomy in pet animals can be seen as acceptably low. In 29 of 34 craniotomies, dura mater defects were left unsutured and no adverse effects were seen.     

Radiographic characterization of enlarged sternal lymph nodes in 71 dogs and 13 cats

In this retrospective study, radiographically enlarged sternal lymph nodes (LNs) were evaluated in 71 dogs and 13 cats for average size, location, and most representative radiographic view. Concurrent clinical diagnoses were also noted and grouped into one of three following categories: neoplastic, inflammatory, or hematologic. There were no statistically significant differences in LN size between lateral views within each species. Enlarged sternal LNs were more cranially positioned in dogs than cats. No statistical difference was noted between right and left laterals, as to on which projection the enlarged sterna lymph nodes was seen best. Neoplastic disease (78.9%) was the most prevalent condition seen in association with LN enlargement in dogs, followed by primary infectious or inflammatory diseases (14.1%) and various hematologic conditions (7.0%). In cats, neoplasia was also most common (69.2%), followed by inflammatory diseases (30.8%). No hematologic conditions were noted in cats. The most common etiologic agent seen concurrently with enlarged sternal LNs in both dogs (33.8%) and cats (38.5%) was malignant lymphoma. The results of this study provide a clinically useful representation of the average size and location of radiographically enlarged sternal LNs for dogs and cats. The diseases represented demonstrate the wide spectrum of potential causes of sternal lymphadenopathy.     

DYNAMIC MAGNETIC RESONANCE IMAGING OF THE NORMAL CANINE PITUITARY GLAND

The pituitary glands of six normal dogs were evaluated using dynamic magnetic resonance imaging. T1 weighted images were obtained every 13 seconds for three minutes of three contiguous slices through the pituitary gland following a bolus intravenous injection of gadolinium-DTPA. Contrast enhancement was seen initially in the region of the pituitary stalk at 52-65 seconds followed by uniform enhancement at 104-143 seconds post injection. This pattern of enhancement was seen in all subjects and is similar to that reported in humans.