Monday 9 January 2012

Dural Tail Sign – Meningioma

Dural tailing is seen on post contrast T1w MRI images, as focal thickening of the enhancing dura adjacent to the mass that resembles a tail extending from the lesion.
The sign first described by Wilms and colleagues in relation to Meningioma.
Goldsher and his associates in 1990, adopted three criteria to define dural tailing radiologically;
1. The tail should be identified on two successive sections,
2. The focal thickening should taper smoothly away from the mass and
3. The intensity of enhancement same or greater than that of the mass.
Based on these criteria dural tail sign was demonstrated in 60% of meningioma cases and it was concluded that its presence was very specific for meningioma.

Many non meningioma cases have now been reported with dural tails, like chloroma, primary central nervous system lymphoma, sarcoidosis, vestibular schwannoma, metastatic tumor, syphilitic gumma, and an aggressive papillary middle ear tumor.
So the Dural tailing is one of the supportive findings for radiological diagnosis of Meningioma and not specific for Meningioma.
It was initially proposed that dural tails resulted from direct tumor invasion but most of studies later failed to demonstrate any direct tumor involvement histopathologically. It is now therefore proposed that dural tails represents reactive change of adjacent dura mater.

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