Dural Tail Sign
Miral D. Jhaveri, MD
DIFFERENTIAL DIAGNOSIS
Common
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Meningioma
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Metastases, Meningeal
Less Common
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Neurosarcoid
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Lymphoma, Metastatic, Intracranial
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Tuberculosis
Rare but Important
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Histiocytosis
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Meningioma, Atypical and Malignant
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Erdheim-Chester Disease
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Leukemia
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Lymphocytic Hypophysitis
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Pituitary Macroadenoma
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Hemangioma, Calvarial
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Schwannoma
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Rosai-Dorfman Disease
ESSENTIAL INFORMATION
Key Differential Diagnosis Issues
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“Dural tail” actually a 3D “collar” around dural-based lesion
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Benign reactive dural thickening > neoplastic invasion
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Suggestive of meningioma but not pathognomonic
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Look for scalp, skull lesions
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Clinical history, laboratory helpful
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Biopsy may be necessary for confirmation
Helpful Clues for Common Diagnoses
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Meningioma
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35-80% of intracranial meningiomas associated with dural tail
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More common with convexity, falx meningiomas
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Less frequently seen in posterior fossa
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Least common in spine
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Usually reactive change rather than direct neoplastic invasion
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Metastases, Meningeal
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Adjacent skull often but not always infiltrated
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Often but not always multifocal
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Often known extracranial primary neoplasm: Prostate, breast, neuroblastoma
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Beware: Breast metastasis can mimic meningioma!
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Helpful Clues for Less Common Diagnoses
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Neurosarcoid
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Occasionally (5%) presents as solitary, dural-based, extra-axial mass
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Presence of associated leptomeningeal enhancement additional clue
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Abnormal CXR, lab values (ESR, ACE levels elevated)
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Lymphoma, Metastatic, Intracranial
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Localized dural mass mimics meningioma
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Dural tail probably infiltrative tumor
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Tuberculosis
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Basilar leptomeningitis common
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Dural involvement less common
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Focal dural mass may mimic meningioma
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Image Gallery
![]() Axial T1 C+ FS MR shows classic convexity meningioma with dural tail sign
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