Metastasen der Dura

Dural masses:
meningiomas and their mimics. Breast cancer metastasis. a Post-contrast axial CT showing a strongly enhancing extra-axial lesion with a wide dural base and associated vasogenic oedema. There is no bony hyperostosis or erosion. b T2-weighted axial image of the same lesion which has an indistinct cortical interface suggestive of involvement. c Post-contrast axial T1-weighted MR image of the lesion with some slight heterogeneous but strong enhancement. d Diffusion-weighted imaging demonstrated intermediate restricted diffusion within the lesion
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Dural masses:
meningiomas and their mimics. Non-germ cell seminoma metastasis. a Sagittal unenhanced CT image showing an irregular and hyperdense extra-axial mass with a wide dural attachment and only minimal vasogenic oedema. b Sagittal CT image on the bone windowing showing bony destruction adjacent to the lesion (white arrowheads) and no hyperostosis. c Post-contrast sagittal T1-weighted MR image showing only minimal irregular peripheral enhancement and no dural tail. The sagittal sinus is involved and occluded. On unenhanced T1-weighted images, the lesion was isointense to white matter and contained small areas of T1-shortening consistent with haemorrhage. d Coronal T2-weighted image of the same lesion
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Dural masses:
meningiomas and their mimics. Dural glioblastoma metastasis. a Post-contrast sagittal T1-weighted MR image showing an avidly enhancing intra-dural, extra-medullary lesion within the upper posterior cervical spine. An enhancing dural tail is seen superiorly (white arrow). b T2-weighted sagittal images of the same lesion. c, d Axial T1 and T2-weighted images show the posterior intra-dural and extra-medullary location of the lesion which is compressing the cord to the left
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Dural or pachymeningeal metastases are a relatively common cause of dural masses, although they are less common than brain metastases and meningiomas. They can occur both within the spine and intracranially - this article is focused on intracranial dural masses.

Clinical presentation

Patients may present with headache, fatigue, confusion and focal neurology such as contralateral motor and sensory changes or cranial nerve involvement . A significant number (~20%) may be clinically occult.

Pathology

There are four mechanisms by which intracranial dural metastases are thought to occur :

The primary malignancies that may cause dural metastases include (in descending order of frequency) :

Radiographic features

MRI

Dural metastases present as a focal mass, although there are typically multiple lesions. Signal characteristics include:

  • T1: typically iso/hypointense to adjacent cortex
  • T2: iso/hyperintense to adjacent cortex
  • T1 C+ (Gd): vivid enhancement
  • MR spectroscopy:
    • increased choline/creatine ratio
    • prominent lipid peak
    • occasional lactate peak
    • absence of NAA peak

Differential diagnosis

When mass like the differential diagnosis is essentially that of other dural masses particularly:

  • meningiomas: can look indistinguishable; dural based mass with "dural tail", hyperostosis and calcification; MRS: increased alanine peak and no lipid/lactate peak
  • hemangiopericytoma: can look identical; often has prominent T2 flow voids
  • CNS lymphoma dural involvement: diffusely enhancing dural mass, often multifocal, T2 low signal due to hypercellularity, no calvarial invasion
  • gliosarcoma: rare; often with dural involvement; heterogeneously enhancing parenchymal mass
  • leukemia/myeloma
  • CNS tuberculosis: strong dural thickening and enhancement with basilar predominance; usually abnormal chest x-ray; more common endemic areas and in immunocompromised patients
  • neurosarcoidosis: multifocal dural based masses; leptomeningeal enhancement; no skull involvement; abnormal chest x-ray and serum markers
  • chronic subdural hemorrhage: trauma history, fluid-fluid levels; varying density/intensity
  • extramedullary hematopoiesis: chronically anemic patients; smooth homogeneous dural based masses with strong homogeneous enhancement

When more diffuse the differential also includes other causes of dural enhancement, and sometimes if thin or irregular, it may be difficult to distinguish pachymeningeal metastases from leptomeningeal metastases or other leptomeningeal processes.

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Metastasen der Dura:
Meningeosis
neoplastica
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