Dural Tail Sign

Dural Tail Sign
Miral D. Jhaveri, MD
DIFFERENTIAL DIAGNOSIS
Common
  • Meningioma
  • Metastases, Meningeal
Less Common
  • Neurosarcoid
  • Lymphoma, Metastatic, Intracranial
  • Tuberculosis
Rare but Important
  • Histiocytosis
  • Meningioma, Atypical and Malignant
  • Erdheim-Chester Disease
  • Leukemia
  • Lymphocytic Hypophysitis
  • Pituitary Macroadenoma
  • Hemangioma, Calvarial
  • Schwannoma
  • Rosai-Dorfman Disease
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
  • “Dural tail” actually a 3D “collar” around dural-based lesion
  • Benign reactive dural thickening > neoplastic invasion
  • Suggestive of meningioma but not pathognomonic
  • Look for scalp, skull lesions
  • Clinical history, laboratory helpful
  • Biopsy may be necessary for confirmation
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
Image Gallery
Axial T1 C+ FS MR shows classic convexity meningioma with dural tail sign image. Note that benign (reactive) dural thickening is slightly more hyperintense than neoplasm itself.

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Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Dural Tail Sign

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