With the advancement and popularity of imaging techniques such as MRI and CT, more and more asymptomatic or mildly symptomatic brain tumors can be detected early. Meningiomas are the most common intracranial primary tumors, and most of them grow slowly. The MRI presentation of meningioma has certain characteristics and most of them can be initially diagnosed by MRI, but there are some tumors that are difficult to distinguish from meningioma on MRI images, and many of them are tumors with malignant tendency that need to be distinguished from meningioma and treated with a more aggressive treatment plan. Ms. Zhang, 35 years old, is a company employee who recently experienced occasional dizziness and difficulty concentrating. A CT examination of her head at the hospital revealed a shadow, so she came to the hospital for further MRI examination and found a tumor the size of a quail’s egg in the left temporal region, which was initially diagnosed as a meningioma. Ms. Zhang underwent microscopic resection of the tumor, and the tumor was completely removed during the surgery. After the surgery, Ms. Zhang recovered well and quickly went back to her normal work and life, but unfortunately the final pathological diagnosis of the tumor was not a meningioma, but an isolated fibrous tumor. This type of tumor is not really benign and is also more prone to recurrence after surgical removal than WHO grade I meningiomas. Although meningiomas have a relatively characteristic presentation on MRI images, they are not really accurately diagnosed based on MRI. MRI can make a preliminary diagnosis of meningioma, but it is difficult to further distinguish between malignant meningiomas that are prone to recurrence or benign meningiomas that are slow growing. Moreover, some benign brain tumors such as nerve sheath tumors in the pontocerebellar horn region and pituitary tumors in the saddle region are sometimes difficult to distinguish from meningiomas in these areas on magnetic resonance imaging. In addition, some types of tumors such as isolated fibrous tumors, perivascular cell tumors, meningeal metastases and other malignant tumors are also difficult to distinguish from meningiomas on MRI. These tumors grow faster and require aggressive treatment options such as surgical resection or even adjuvant radiation therapy treatment as soon as possible. Therefore, meningioma should not be taken lightly after MRI diagnosis, and malignant brain tumors that look similar to meningioma should not be treated as meningioma.