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I'm here with my brilliant young colleague,

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Dr. Ben Laser.

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We're talking about the vascular makeup of meningiomas.

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This is a 43-year-old man with a huge falcine meningioma

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with left-sided symptoms from compression.

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The meningioma is on the right side.

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It's a huge falcine meningioma seen on T1,

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T1 C+ and T1 coronal.

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So this is an axial, this is a coronal,

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T1 C+.

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And this lesion demonstrates some rather intense

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enhancement with some dural enhancement.

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We talked previously about the mother-in-law sign.

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Both of us are successfully married.

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Mother-in-laws are terrific.

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They come early to help you out with the kids,

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but they also stay late to babysit

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to help you out with the kids.

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Some people say that the enhancement of a meningioma

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is intense, kind of like your mother-in-law.

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But the question that I have is why?

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And you know there are some normal areas of

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the brain that normally enhance,

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like the dura and the choroid plexus,

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and the area postrema and the pineal gland.

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So why do meningiomas have this intense enhancement,

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not unlike some normal structures?

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So these normal structures that Dr. Pomeranz

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has just described, all have a type

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of fenestration in their capillaries.

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There's three different types of capillaries.

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You have the continuous capillary,

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you have the sinusoidal capillaries,

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and then you have the fenestrated capillaries.

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The fenestrated capillaries, in all these areas, take up

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enhancement and allow the blood that has the contrast

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to enhance these regions.

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So, they're more leaky.

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So they're more leaky.

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Essentially, the vessels are leaky,

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and that's why the meningioma enhances

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so rapidly and avidly.

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So, basically what happens is

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these normal blood vessels

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that are different, the subtype of capillary

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known as autochthonous blood supply in these areas become

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too proliferative in the meningioma and allow very rapid

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leakage of gadolinium or the contrast

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agent into the lesion,

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producing a mass that exhibits the mother-in-law sign,

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comes early, stays late.

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It's intense.

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Let's move on, shall we?