Dural tumors made easy (radiology)

DURAL TUMOURS.

Dr. NIKRISH S HEGDE

MENINGIOMA

Most common tumor to originate

from the meninges.

Most common non glial primary brain

tumor.

M:F 1:2 ; 40 – 60 yrs

HISTOLOGY.Meningothelial cells.

Specialised meningothelial cells

known as arachnoid cap cell.

Few arise from dural fibroblasts.

Choroid plexus and Arachnoid

associated with cranial nerves.

CYTOGENETIC.

Chromosome 22

Neurofibromatosis type 2

Related to sex hormones.

Common in women, correlated with

breast cancer and increase in size in

pregnancy.

Hormonal receptors.

GROSS

Globose : spherical or lobulated

Enplaque: flat , carpet like infiltrative lesion.

Sessile / Pedunculated

CLASSIC DESCRIPTION

Syncytial

Fibrous

Transitional

Angioblastic

WHO CLASSIFICATION

Benign

Atypical

Anaplastic

LOCATION

Extra axial dural based lesions.

Majority are supratentorial

Dural venous sinuses, confluence of

cranial sutures & arachnoid

granulations.

Parasagittal 25%

Convexity 20%

Sphenoid ridge 20%

Olfactory 5%

Para sellar 5%

Posterior fossa 10%

C/F

Asymptomatic

10% symptomatic

Depends on the locations

Hemiparesis and seizures

Visual field defects

Multiple cranial nerve palsies

Anosmia

IMAGING

Plain Film

Angiography

CT

MRI

PLAIN FILM

Bone erosions

Hyperostosis

Tumoral calcifications

Enlarged Vascular channels

ANGIOGRAPHY

Dual supply

Centrally – Sunburst Pattern &

peripherally by pial branches

Late phase – mother in law sign

CT

Well circumscribed lobulated mass

Abuts the dural surface at obtuse angle.

Majority are hyperdense

Calcification and bone destruction

Edema

NECT

90% homogenous enhancement

5-10% rim like enhancement

Inhomogeneous enhancement-

mushrooming

MRI

CSF cleft

Displaced grey white matter

interface

4 th ventricle compressed

Ipsilateral CPA Cistern enlarged

T1 -   

isointense: ~ 60-90%

somewhat hypointense: ~ 10-

40% compared to grey matter

T2 -

isointense: ~ 50%

hyperintense: ~ 35-40%

very hyperintense lesions may

represent the microcystic variant 12

hypointense: ~ 10-15% compared to

grey matter

T1 C+ (Gd) - usually intense and

homogenous enhancement.

Moderate to severe peritumoral

edema.

Dural tail sign.

DURAL TAIL SIGN

occurs as a result of thickening of the

dura

DWI

atypical and malignant sub types may

show greater than expected restricted

diffusion although recent work suggests

that this is not useful in prospectively

predicting histological grade

HEMANGIOPERICYTOMA

“Uncertain origin”

Well circumscribed lesions

Highly Vascular.

40-60 yrs

Male preponderance

Show recurrences and extra

neural metastasis.

ANGIOGRAPHY

Hypervascular

Heterogeneous tumor stain

Dual Supply

CT

NECT – Heterogeneous

CECT – Heterogeneous

enhancement

Cystic and necrotic areas

MRI

Extra axial

T1 – Iso

PD – Hyper

T2 - Hetero

Shows inhomogenous enhancement.

MELANOCYTOMA

Benign tumours.

Leptomeningeal melanocytes.

Locations - Foramen magnum, the

posterior fossa, Meckel’s cave, or

adjacent to cranial nerve nuclei.

C/F

4th – 5th decade

Size & Location.

Pain , weakness & sensory

defecits.

CT

NECT - hyper

well defined lesion

CECT – Homogeneous

enhancement.

MRI

T1 : isointense or hyperintense

T2 : isointense or hypointense

T1 C+ (Gd) : heterogenous enhancement

T2* GRE : may show blooming of low

signal

DURAL METSsolid tumours

lung cancer

breast cancer

melanoma

haemopoietic neoplasms

lymphoma

leukaemia

CT

MRI

THANK YOU