Dural Tail Sign

Miral D. Jhaveri, MD

DIFFERENTIAL DIAGNOSIS

Common

Less Common

Rare but Important

ESSENTIAL INFORMATION

Key Differential Diagnosis Issues

Helpful Clues for Common Diagnoses

Meningioma
- 35-80% of intracranial meningiomas associated with dural tail
- More common with convexity, falx meningiomas
  - Less frequently seen in posterior fossa
  - Least common in spine
- Usually reactive change rather than direct neoplastic invasion
Metastases, Meningeal
- Adjacent skull often but not always infiltrated
- Often but not always multifocal
- Often known extracranial primary neoplasm: Prostate, breast, neuroblastoma
- Beware: Breast metastasis can mimic meningioma!

Helpful Clues for Less Common Diagnoses

Neurosarcoid
- Occasionally (5%) presents as solitary, dural-based, extra-axial mass
- Presence of associated leptomeningeal enhancement additional clue
- Abnormal CXR, lab values (ESR, ACE levels elevated)
Lymphoma, Metastatic, Intracranial
- Localized dural mass mimics meningioma
- Dural tail probably infiltrative tumor
Tuberculosis
- Basilar leptomeningitis common
- Dural involvement less common
- Focal dural mass may mimic meningioma