A review on dural tail sign

"Dural tail sign" (DTS) which is a thickening of the dura adjacent to an intracranial pathology on contrast-enhanced T1 MR Images, was first thought to be pathognomonic of meningioma, however, many subsequent studies demonstrated this sign adjacent to various intra- and extra-cranial pathologies and in spinal lesions. In this paper we outline the history, accompanying pathologies and the differentiation and probable pathophysiology of DTS. We also discuss whether we can predict tumoral involvement of the dural tail before surgery and whether the dural tail adjacent to a tumor should be resected.     

MRI appearances mimicking the dural tail sign: a report of two cases

We report two cases in which the MRI appearances mimicked the dural tail sign; a glioma extending into the subarachnoid space, and a meningioma extending to the subdural space. They indicate that tumour invasion into the subarachnoid or subdural space, should be considered when prominent linear enhancement is observed along the dura mater adjacent to tumours. Received: 31 March 1999/Accepted: 21 July 1999     

The dural tail of intracranial meningiomas on fluid-attenuated inversion-recovery images

We evaluated the dural tail associated with 48 intracranial meningiomas on fluid-attenuated inversion-recovery (FLAIR) and contrast-enhanced T1-weighted images. In 30 (62.5%), a dural tail was observed on contrast-enhanced T1-weighted images, and thickening of the dura mater and abnormal signal were identified in the corresponding region on FLAIR images. Thus, FLAIR imaging was useful for showing dural abnormality associated with meningiomas without the needed for contrast medium.     

Dural tail sign in spinal meningiomas

OBJECTIVE: To study the association between the "dural tail sign" and spinal meningiomas on MR imaging. METHODS: Retrospective review of MR examinations of all pathologically proven spinal meningiomas from 1998 to 2005 was performed. Lesions were evaluated for size, signal intensity, enhancement pattern, and presence or absence of dural tail. The dural tail length and direction in reference to the meningioma were also evaluated. RESULTS: Seven spinal meningiomas were identified in seven patients. One lesion was purely extradural, while the remaining were intradural extramedullary. Dural tail was present in four cases (57%) and its length ranged between 5 and 21 mm. The tail was seen cranial and caudal to the meningioma in three cases and only cranially in one. Coronal images were available in three cases and in two of these; the dural tail was clearly depicted. CONCLUSIONS: "Dural tail sign" is as common in spinal meningiomas as in cranial meningiomas.     

“Dural tail” adjacent to a giant posterior cerebral artery aneurysm: case report and review of the literature

The “dural tail” sign on gadolinium (Gd-DTPA)-enhanced MRI has been described in association with meningiomas. Various series with histopathological correlation have shown that in some cases there is tumour invasion into the dura mater, but in the majority of cases it represents a hypervascular, non-neoplastic reaction. While this sign was originally thought to be specific for meningioma, subsequent case reports have described the presence of a dural tail in other intra- and extra-axial lesions. We present a patient with a giant aneurysm arising from the P2 segment of the right posterior cerebral artery, adjacent to the tentorium, with a prominent dural tail on Gd-DTPA-enhanced MRI. In this location, differentiation of an aneurysm from a meningioma was critical. Received: 24 September 1996 Accepted: 7 October 1996     

Pathologic significance of the "dural tail sign"

Objective

The exact nature of the “dural tail sign” (thickening of the dura adjacent to the tumour in contrast enhanced T1-MRI imaging) is still not clearly established. In this study we tried to verify the histological appearance of the “dural tail sign” and probable correlation between different MRI findings and dural tail histology.

Material and methods

In this study, 129 patients with intracranial lesions underwent MRI imaging with 1.5 T scanner. The “dural tail sign” was defined using Goldsher et al. criteria. Size and pattern of enhancement of the tumour and adjacent dura was noted in MRI and in the pathologic samples, dural tail and the dura beneath the tumour was assessed.

Results

In 30 cases, “dural tail sign” was evident on MRI, dural tail noted in 17 of these cases in histological samples (12 meningiomas, 3 pituitary adenomas and 2 schwannomas). All of them had vessel dilatation, 6 showed tumoural invasion, 4 demonstrated intravascular growth of the lesion and 1 showed inflammation of the dura.

Conclusion

In our study MRI findings failed to predict tumoural invasion of the dural tail in histologic samples and because of frequent presence of tumour nests in it, the dura matter should be resected as widely as possible.     

Intracranial adenoid cystic carcinoma mimicking meningioma: report of two cases

Two cases of intracranial adenoid cystic carcinoma mimicking meningioma are reported. In one, MRI showed not only a homogeneously enhancing extra-axial tumour attached to the dura mater of the posterior cranial fossa, but also surrounding dural enhancement, the dural tail sign. In the second, CT demonstrated a well-demarcated enhancing extra-axial tumour, indistinguishable from a sphenoid ridge meningioma extending into the orbit. The neuroradiological features of intracranial adenoid cystic carcinoma may thus closely resemble those of meningioma.     

Dural arteriovenous fistula associated with neoplastic dural sinus thrombosis: two cases

Intracranial dural arteriovenous fistulae are direct arteriovenous shunts within the dura matter. We report two cases of arteriovenous fistulae upstream to a neoplastic dural sinus thrombosis. These cases add further support to the acquired etiology of dural arteriovenous fistulae and to the fact that venous hypertension is one of the most important precipitating factors. Received: 9 January 2001/Accepted: 10 January 2001     

Diagnosing dural metastases: the value of 1H magnetic resonance spectroscopy

The purpose of this study was to assess the value of MRI, MR spectroscopy (MRS) and intra-arterial angiography in the preoperative diagnosis of extra-axial dural-based masses. We prospectively studied 54 patients who underwent preoperative MRI, MRS and angiography. Histologically there were 50 meningiomas and four dural metastases. MRI and angiography did not allow reliable differentiation between meningiomas and metastases. MRS showed elevated choline/creatine ratios in both meningiomas and metastases, but there were prominent lipid signals in all metastases and a lactate peak in two. This spectroscopic pattern was not found in meningiomas. However, following embolisation, they showed similar spectra, due to ischaemia and necrosis. We therefore believe MRS to be valuable in differential diagnosis of dural metastases and meningiomas prior to embolisation. Received: 4 April 2000 Accepted: 6 October 2000     

“Dural tail” adjacent to acoustic neuroma on MRI: a case report

A dural tail on Gd-DTPA-enhanced MRI has been often observed adjacent to meningiomas and considered to be useful in distinguishing meningioma of the cerebellopontine angle from acoustic neuroma. However, demonstration of a dural tail adjacent to an acoustic neuroma indicates that this sign is not specific.     

Intracranial dural metastatic prostate cancer can mimic meningioma: a report of two cases

Cerebral metastases from any malignancy, including prostate carcinoma, may present as a meningeal mass, and differentiating the lesion from a meningioma can be challenging. We report the clinical and neuroimaging features of two patients with dural metastases from prostate carcinoma and discuss differentiation of metastatic lesions from meningioma. In both patients, it appeared that the prostate carcinoma had been successfully treated, and neither patient was found to have any other metastases at the time of diagnosis of the dural lesions.     

Dural invasion of meningiomas adjacent to the tumor margin on Gd-DTPA-enhanced MR images: histopathologic correlation

In intracranial meningiomas a flat, contrast-enhancing, dural structure adjacent to the tumor can occasionally be observed on gadolinium-DTPA-enhanced MR images. We wished to evaluate whether there is a correlation between MR images and meningeal invasion of intracranial meningiomas. The study included 54 patients with intracranial meningioma and the meningeal sign. MR studies included T2-weighted and gadolinium-DTPA-enhanced T1-weighted images in axial, coronal, and sagittal planes. Histopathologic examinations were done on the meningiomas adjacent to the dura mater. The meningeal sign on MRI was observed from 2 up to 35 mm from the main tumor mass in 31 (57 %) of the 54 patients. In 20 of these 31 the histopathologic examination showed tumor invasion, while 11 patients had no tumor invasion but tissue proliferation, hypervascularity, and vascular dilatation. Seven of the 23 meningiomas without the meningeal sign had histologically proven infiltration of the adjacent dura. MR imaging is not able to determine definitive whether or not there is dural infiltration of the meningiomas. In conclusion, resection of the tumor with a wide margin is necessary to achieve complete excision of meningioma and to avoid recurrence. Received 23 July 1997; Revision received 10 October 1997; Accepted 17 October 1997     

Clear-cell meningioma of the cauda equina

Meningiomas are rare tumours in children and lumbar lesions are exceptional. We report a clear-cell meningioma (CCM) of the cauda equina in a 10-year-old girl. The tumour was diagnosed by MRI, showing an enhancing intradural mass extending from L1 to L4. Pathology and immunohistochemical study demonstrated a CCM. The patient had a recurrence 6 months after the operation requiring further surgery. CCM are rare lesions, characterised by abundant cytoplasmic glycogen particles. Complete surgical removal is necessary because, despite their benign histological appearance, CCM are potentially aggressive and may recur, spread locally and even metastasize. Received: 25 September 1997 Accepted: 25 February 1998     

脑膜尾征”：与脑膜瘤相关的MR强化表现

目的分析脑膜瘤脑膜尾征的MR表现及组织学特点。方法对32例脑膜瘤患者均行MR平扫及增强扫描。结果32例34个脑膜瘤病灶中有23个病灶（67.6%）显示脑膜尾征,且与肿瘤的大小与位置无关。结论脑膜尾征是脑膜瘤在MR增强扫描时较常见和特有的表现,而且脑膜尾征与肿瘤侵犯脑膜部分相关。     

颅内粒细胞肉瘤诊断并文献复习

目的探讨粒细胞肉瘤的临床、病理及影像特点,以提高对粒细胞肉瘤的认识。方法回顾性分析1例经手术病理证实的颅内粒细胞肉瘤病人的临床、影像及病理资料,并复习相关文献。结果 MRI上左侧中颅窝可见一等T1稍长T_2信号肿物,边界清晰。T_2WI上病灶周边较中心信号略高,冠状面示肿物以宽基地与颅底相连,邻近颅底骨质局部信号略显增高,相邻脑皮质向脑内推移,脑沟变浅,并可见小片状长T_2水肿信号,同侧中耳乳突腔内可见蜂窝状长T_2信号。液体衰减反转恢复(FLAIR)序列上肿物呈稍高信号。DWI上明显扩散受限。ADC图上信号明显减低。增强后,肿物明显强化,且周边较中心强化略明显,矢状面及冠状面肿物基底部邻近硬膜可见"脑膜尾征"。结论粒细胞肉瘤的影像表现存在一定的特点,但不能作为诊断的特异性标志,最终诊断需要结合临床白血病病史及病理组织学检查。     

Pineal meningioma: MRI

Pineal meningiomas are very rare. We report a pineal meningioma examined by MRI.     

侧脑室脑膜瘤的磁共振表现

目的：通过分析侧脑室脑膜瘤的磁共振特征,以提高诊断准确性。方法分析手术病理证实的27例侧脑室脑膜瘤的磁共振资料,总结其磁共振影像特点。结果25例位于侧脑室后角及三角区（其中19例位于左侧、6例位于右侧）、1例位于侧脑室体部、1例为多发。所有肿瘤M RI均表现为边界清楚的肿块影。22例肿瘤形态呈圆形（81．5％）,5例浅分叶（18．5％）,1例深分叶。信号均与脑灰质对比,T1 WI呈等高或稍低信号,T2 W/FLAIR呈等或稍高信号,与脑室外脑膜瘤信号基本一致。T1 WI增强扫描多数为明显强化,并显示肿块边缘与脉络丛相连。肿瘤病理类型：19例为纤维型、8例为上皮型。测ADC平均值分别为纤维型（0．89±0．12）×10-3mm2/s ,上皮型（0．95±0．18）×10-3mm2/s。结论侧脑室脑膜瘤具有一定的M RI征象,可以提高术前诊断的准确性。     

脑膜瘤的MRI征象及相关病理(附51例病例分析)

目的:分析脑膜瘤MRI表现及其相关病理.方法:回顾性分析51例经手术证实的脑膜瘤MRI图像,从其信号特点、肿瘤-脑组织界面、瘤周水肿、脑膜尾征病灶增强后MRI信号均匀度等方面进行归纳,并观察相关病理学资料.结果:脑膜瘤大多T1WI为等低信号,T2WI以稍高信号和混杂信号多见,脑膜尾征具有诊断价值.结论:脑膜瘤MRI征象有较高的敏感性和特征性,大多数能在术前诊断,为手术方式提供帮助.     

富于淋巴浆细胞型脑膜瘤的MRI与病理分析

目的 探讨脑膜瘤亚型富于淋巴浆细胞型的MRI表现特征.方法 回顾性分析7例经手术病理证实的富于淋巴浆细胞型脑膜瘤的影像资料及病理资料,结合相关文献进行对比分析.结果 7例富于淋巴浆细胞型脑膜瘤均为单发病灶,6例病灶沿脑膜匍匐性生长,5例未形成具体瘤结节,2例为不规则分叶状;7例病灶均界限不清,瘤周水肿明显,邻近脑组织不同程度受累.MR平扫T1WI 7例均呈等、略低信号,T2WI 5例呈等、略高信号,2例呈等、略低信号;增强扫描见7例病灶均有显著强化效应,6例脑膜广泛不均匀增厚.病理示细胞丰富,成分多样,见大量淋巴细胞、浆细胞浸润,可见多少不等的梭形瘤细胞及典型脑膜上皮细胞区域.结论 富于淋巴浆细胞型脑膜瘤影像表现不同于常见脑膜瘤,具有一定的影像表现特征,有助于该肿瘤的诊断和鉴别.     

Retrograde flow in the dural sinuses detected by three-dimensional time-of-flight MR angiography

Introduction Retrograde flow in the left dural sinuses is sometimes detected by three-dimensional time-of-flight (3D-TOF) magnetic resonance (MR) angiography. The purpose of this study was to evaluate the incidence of this phenomenon and its characteristic features on 3D-TOF MR angiograms. Methods We retrospectively reviewed cranial MR angiography images of 1,078 patients examined at our institution. All images were obtained by the 3D-TOF technique with one of two 1.5-T scanners. Maximum intensity projection (MIP) images in the horizontal rotation view were displayed stereoscopically. We reviewed the source images, inferosuperior MIP images, and horizontal MIP images and identified retrograde flow in the dural sinuses. Results We found retrograde flow in the dural sinuses of 67 patients on the source images from 3D-TOF MR angiography; the incidence was 6.2%. In 47 of the 67 patients, retrograde flow was identified in the left inferior petrosal sinus, in 13, it was seen in the left sigmoid sinus, and in 6, it was seen in the left inferior petrosal and left sigmoid sinuses. The remaining patient had retrograde flow in the left inferior petrosal and left and right sigmoid sinuses. The mean age of the patients with retrograde flow was slightly greater than that of the patients without this phenomenon (70 years vs 63 years). Conclusion Retrograde flow in the dural sinuses frequently occurs on the left side in middle-aged and elderly patients during 3D-TOF MR angiography performed with the patient in the supine position. This phenomenon should not be misdiagnosed as a dural arteriovenous fistula. This article was presented as an electronic poster paper at the 31st Congress of the ESNR held in Geneva in September 2006.