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The "dural tail" adjacent to meningiomas studied by dynamic contrast-enhanced MRI: a comparison with histopathology
T Nägele1, D Petersen, U Klose
1Abteilung für Neuroradiologie, Radiologische Klinik der Universität Tübingen, Germany.
Abstract:
We examined 32 patients with intracranial tumors (17 meningiomas, 8 neuromas, 7 pituitary adenomas) by conventional and dynamic contrast-enhanced MRI. Our aim was to clarify whether the pathological dural contrast enhancement adjacent to meningiomas (the "dural tail") is specific to meningiomas and, more important, whether it represents neoplastic dural infiltration or hypervascularization as a tumor accompanying reaction. A "dural tail" was found in 9 of 17 meningiomas. None of the other extra-axial tumours (neuromas, pituitary adenomas) showed comparable dural enhancement. Dynamic examinations with an ultrafast single slice imaging technique (snapshot-FLASH) after a bolus injection of contrast medium showed a "dural tail" in seven out of these nine meningiomas, while in two cases the "dural tail" turned out to be a cortical vein with a characteristic dynamic contrast enhancement pattern. In the dynamic study all seven "dural tails" were found to have earlier, steeper contrast enhancement than the corresponding tumours. All the tumours and part of the adjacent dura mater in four of the seven meningiomas with dural enhancement were examined histopathologically. In none of these four cases was neoplastic tissue found more than 2 mm away from the main tumour. The results strongly support the suggestion that the "dural tail" adjacent to meningiomas represents a hypervascular, non-neoplastic dural reaction.
Insights
The "dural tail" sign seen on MRI near meningiomas is not specific to neoplastic infiltration. Dynamic MRI and histopathology confirm it represents a hypervascular, non-neoplastic dural reaction.
Area of Science:
- Neuroradiology
- Neuro-oncology
- Medical imaging
Background:
- The "dural tail" sign on contrast-enhanced MRI is often associated with meningiomas.
- Its pathological significance, whether neoplastic infiltration or reactive change, remains debated.
Purpose of the Study:
- To determine the specificity of the "dural tail" sign for meningiomas.
- To differentiate between neoplastic dural infiltration and reactive hypervascularization in the "dural tail".
Main Methods:
- Conventional and dynamic contrast-enhanced MRI were performed on 32 patients with intracranial tumors (meningiomas, neuromas, pituitary adenomas).
- Dynamic imaging utilized an ultrafast snapshot-FLASH sequence following contrast bolus injection.
- Histopathological examination of tumors and adjacent dura was conducted in select cases.
Main Results:
- A "dural tail" was observed in 9 of 17 meningiomas; none were seen with neuromas or pituitary adenomas.
- Dynamic MRI identified "dural tails" in 7 meningiomas, with 2 cases reclassified as cortical veins.
- Histopathology revealed neoplastic infiltration <2mm from the tumor in only these cases, supporting a reactive dural process.
Conclusions:
- The "dural tail" sign adjacent to meningiomas is not specific for neoplastic dural infiltration.
- It represents a hypervascular, non-neoplastic dural reaction to the underlying tumor.