Figure 1: This AM demonstrates some characteristics of lower-grade meningioma, including calcification on CT imaging (top left), but on bone algorithm CT imaging, permeative bony infiltration can be seen (top right). This is a finding suggestive of a higher-grade tumor. Most lower-grade meningiomas tend to exhibit underlying hyperostosis. Axial FLAIR imaging (bottom left) demonstrates vasogenic edema associated with the medial left parietal mass, presumably due to irritative parenchymal invasion or venous stasis, given the invasion of this AM into the superior sagittal sinus, as seen on sagittal T1-weighted postcontrast imaging (bottom right).

Figure 2: (Top Right) Thought more difficult to see on T1-weighted axial imaging, this left parieto-occipital convexity MM demonstrates bright enhancement on postcontrast T1-weighted imaging. The irregular contour is more typical of MM than of benign meningioma. (Bottom) Sagittal T2-weighted imaging also demonstrates hyperintense surrounding edema, a feature that is often seen in benign meningioma but should also raise suspicion for a higher-grade lesion.

Figure 3: (Top Left) This MM demonstrates extensive involvement of the skull base and surrounding structures, particularly on postcontrast T1-weighted imaging, where there is encasement of the brightly enhancing carotid arteries and extension through the sella, suprasellar cistern, left middle cranial fossa, and left orbit. (Top Right) Sagittal postcontrast imaging also illustrates how extensive the tumor is, with involvement of the left occipital condyle and extension into the posterior fossa. Significant mass effect on the inferior left frontal lobe can also be seen. (Middle Left) Axial FLAIR imaging shows this mass mildly infiltrating the left cerebellar hemisphere, in addition to skull base, masticator space, and orbital involvement. DWI and ADC (middle right and bottom) show mild restriction, a characteristic common to both benign and malignant meningiomas.