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Objective <p>Intracranial Rosai-Dorfman disease (RDD) and fibrous meningioma, despite exhibiting overlapping features on conventional MRI (cMRI) and CT, are frequently confounded in preoperative diagnosis. This clinical dilemma is critical, as the two entities demand substantially different treatment strategies and are associated with divergent prognoses. The aim of this study was to identify key discriminative imaging features on cMRI, susceptibility-weighted imaging (SWI), and CT to enhance preoperative differentiation between intracranial RDD and fibrous meningioma.</p> Methods <p>This retrospective study included 7 patients with pathologically confirmed intracranial RDD (12 lesions) and 36 patients with fibrous meningioma (36 lesions). All patients underwent preoperative imaging including cMRI, SWI, and CT. Two neuroradiologists independently evaluated imaging features, including signal characteristics, enhancement, perilesional edema, SWI hypointensity, phase image signal, presence of calcification, and the morphological ratio. Interobserver agreement was evaluated using Cohen's kappa coefficient, and intergroup differences were analyzed using the χ2 test and t-test.</p> Results <p>Compared to fibrous meningiomas, RDD lesions demonstrated several distinctive imaging characteristics. A statistically significant difference in sex distribution was observed between the two groups (<i>p</i> = 0.035). In terms of imaging features, RDD lesions consistently showed: (1) different T1 and T2 signal; (2) perilesional edema (100% vs. 25%, <i>p</i>&lt;0.001); (3) diffuse SWI hypointensity throughout the lesion (100% vs. 0%, <i>p</i>&lt;0.001); (4) high phase image signal in the majority of RDD lesions (75% vs. 19.4%, <i>p</i>&lt;0.001); (5) absence of calcification (0% vs. 52.8%, <i>p</i>&lt;0.001); (6) a significantly higher and more variable longest-to-shortest diameter ratio (2.81±2.76 vs. 1.20±0.20, <i>p</i>&lt;0.001). No significant differences were observed in enhancement homogeneity or meningeal enhancement degree.</p> Conclusion <p>The integration of cMRI, SWI, and CT features may aid in differentiating intracranial RDD from fibrous meningioma.</p>

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SWI combined with cMRI and CT in the differentiating of intracranial Rosai-Dorfman disease from fibrous meningioma

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月1日

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  • Xiaoye Lin,
  • Xinying Wang,
  • Yuqiong Wang,
  • Weiqi Su,
  • Feifei Yu,
  • Feng Wang,
  • Dairong Cao,
  • Zhen Xing

摘要

Objective

Intracranial Rosai-Dorfman disease (RDD) and fibrous meningioma, despite exhibiting overlapping features on conventional MRI (cMRI) and CT, are frequently confounded in preoperative diagnosis. This clinical dilemma is critical, as the two entities demand substantially different treatment strategies and are associated with divergent prognoses. The aim of this study was to identify key discriminative imaging features on cMRI, susceptibility-weighted imaging (SWI), and CT to enhance preoperative differentiation between intracranial RDD and fibrous meningioma.

Methods

This retrospective study included 7 patients with pathologically confirmed intracranial RDD (12 lesions) and 36 patients with fibrous meningioma (36 lesions). All patients underwent preoperative imaging including cMRI, SWI, and CT. Two neuroradiologists independently evaluated imaging features, including signal characteristics, enhancement, perilesional edema, SWI hypointensity, phase image signal, presence of calcification, and the morphological ratio. Interobserver agreement was evaluated using Cohen's kappa coefficient, and intergroup differences were analyzed using the χ2 test and t-test.

Results

Compared to fibrous meningiomas, RDD lesions demonstrated several distinctive imaging characteristics. A statistically significant difference in sex distribution was observed between the two groups (p = 0.035). In terms of imaging features, RDD lesions consistently showed: (1) different T1 and T2 signal; (2) perilesional edema (100% vs. 25%, p<0.001); (3) diffuse SWI hypointensity throughout the lesion (100% vs. 0%, p<0.001); (4) high phase image signal in the majority of RDD lesions (75% vs. 19.4%, p<0.001); (5) absence of calcification (0% vs. 52.8%, p<0.001); (6) a significantly higher and more variable longest-to-shortest diameter ratio (2.81±2.76 vs. 1.20±0.20, p<0.001). No significant differences were observed in enhancement homogeneity or meningeal enhancement degree.

Conclusion

The integration of cMRI, SWI, and CT features may aid in differentiating intracranial RDD from fibrous meningioma.