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Dural "tail" associated with meningiomas on Gd-DTPA-enhanced MR images: characteristics, differential diagnostic
D Goldsher1, A W Litt, R S Pinto
1Department of Radiology, New York University Medical Center, NY 10016.
Abstract:
Gadolinium-enhanced magnetic resonance (MR) imaging studies of 30 histologically proved cranial meningiomas revealed a linear enhanced structure or "tail" extending away from the tumor mass along the dural surface in 18 cases (60%). Contrast material-enhanced computed tomographic studies available in 10 of these 18 cases did not depict this structure. Characteristic features of this MR finding were reviewed, and criteria were defined to distinguish this tail from other enhanced structures. To assess the differential diagnostic value of this finding, gadolinium diethylenetriaminepentaacetic acid-enhanced MR studies of a control group of other extraaxial lesions as well as superficial intraaxial tumors that abut the meninges were reviewed. These cases failed to show this MR feature. Pathologic correlation was available in three meningiomas with the finding of a tail, and these demonstrated meningothelial tumor nodules in the samples taken from areas corresponding to the enhanced regions on MR images. This is in agreement with other recent pathologic studies of the dura mater surrounding meningiomas. The authors believe that the linear enhanced structure described may represent tissue containing tumoral nodules. Awareness of this MR sign may be useful in distinguishing meningiomas from other lesions and in planning total resection of the infiltrated dura mater.
Insights
A linear enhancement, termed the "dural tail sign," was observed in 60% of cranial meningiomas using gadolinium-enhanced MRI. This finding aids in differentiating meningiomas from other brain tumors.
Area of Science:
- Neuroradiology
- Neuro-oncology
- Pathology
Background:
- Cranial meningiomas are common primary tumors arising from the meninges.
- Accurate diagnosis and differentiation from other extraaxial lesions are crucial for treatment planning.
- Gadolinium-enhanced magnetic resonance (MR) imaging is a key modality for evaluating intracranial masses.
Purpose of the Study:
- To investigate the prevalence and characteristics of a linear enhanced structure, the "dural tail sign," in cranial meningiomas.
- To assess the diagnostic value of this MR finding in distinguishing meningiomas from other lesions.
- To correlate MR findings with pathological examination.
Main Methods:
- Retrospective review of 30 gadolinium-enhanced MR imaging studies of histologically confirmed cranial meningiomas.
- Comparison with contrast-enhanced computed tomographic (CT) studies where available.
- Review of MR studies of control extraaxial lesions and superficial intraaxial tumors.
- Pathological correlation in cases with the dural tail sign.
Main Results:
- A linear enhanced structure, or "dural tail," was identified in 18 out of 30 (60%) meningioma cases.
- This structure was consistently seen on MR imaging but not on contrast-enhanced CT.
- The dural tail sign was not observed in control extraaxial or intraaxial lesions.
- Pathological examination confirmed meningothelial tumor nodules in the dura mater corresponding to the enhanced regions.
Conclusions:
- The dural tail sign on gadolinium-enhanced MR imaging is a characteristic finding in cranial meningiomas.
- This sign likely represents tumoral infiltration of the dura mater.
- Awareness of the dural tail sign can improve the differential diagnosis of meningiomas and guide surgical planning for complete resection.