Dural tail sign explained

The dural tail sign (also known as "dural thickening", "flare sign", or "meningeal sign") is a radiological finding observed in magnetic resonance imaging (MRI) studies of the brain that refers to a thickening of the dura mater immediately adjacent to a mass lesion, such as a brain tumor.[1] Initially, the dural tail sign was thought to be pathognomonic of meningioma, a slow-growing tumor that arises from the meninges. However, subsequent studies have shown that it can also be observed in various intra- and extra-cranial pathologies and in spinal lesions. It is not a completely sensitive finding, as it is seen in only 60-72% of cases.[2] It is not completely specific either, as it has been described associated with lesions like neuromas, chloromas, pituitary diseases, granulomatous disorders, cerebral Erdheim-Chester disease, lymphomas, metastasis, hemangiopericytomas, schwannomas, and gliomas such as glioblastoma multiforme (GBM).[3] The final diagnosis should be further established through cerebrospinal fluid analysis or histopathological examination following a biopsy.

The dural tail sign was first described in 1989 by Wilms et al..[4] Histopathological correlation from different studies has at times revealed tumor infiltration into the dura mater, however, in most instances, it signifies a hypervascular, non-neoplastic response.

One study showed that including the dural tail in the stereotactic radiosurgery (SRS) or fractionated stereotactic radiotherapy (FSRT) volumes for meningioma treatment did not seem to impact recurrence.[5]

Notes and References

  1. Sotoudeh . Houman . 2010 . A review on dural tail sign . World Journal of Radiology . Baishideng Publishing Group Inc. . 2 . 5 . 188–192 . 10.4329/wjr.v2.i5.188 . 21161034 . 1949-8470. 2999017 . free .
  2. Doddamani . RameshS . Meena . RajeshK . Sawarkar . Dattaraj . 2018 . Ambiguity in the Dural Tail Sign on MRI . Surgical Neurology International . Scientific Scholar . 9 . 1 . 62 . 10.4103/sni.sni_328_17 . 29629229 . 2152-7806. 5875113 . free .
  3. Guermazi . A. . Lafitte . F. . Miaux . Y. . Adem . C. . Bonneville . J.-F. . Chiras . J. . 2005 . The dural tail sign—beyond meningioma . Clinical Radiology . Elsevier BV . 60 . 2 . 171–188 . 10.1016/j.crad.2004.01.019 . 15664571 . 0009-9260.
  4. Wilms . Guy . Lammens . Martin . Marchal . Guy . Calenbergh . Frank Van . Plets . Chris . Fraeyenhoven . Luc Van . Baert . Albert L. . 1989 . Thickening of Dura Surrounding Meningiomas . Journal of Computer Assisted Tomography . Ovid Technologies (Wolters Kluwer Health) . 13 . 5 . 763–768 . 10.1097/00004728-198909000-00003 . 2778133 . 0363-8715.
  5. Piper . Keenan . Yu . Siyuan . Taghvaei . Mohammad . Fernandez . Christian . Mouchtouris . Nikolaos . Smit . Rupert D. . Yudkoff . Clifford . Collopy . Sarah . Reyes . Maikerly . Lavergne . Pascal . Karsy . Michael . Prashant . Giyarpuram N. . Shi . Wenyin . Evans . James . 2022-07-04 . Radiation of meningioma dural tail may not improve tumor control rates . Frontiers in Surgery . Frontiers Media SA . 9 . 908745. 10.3389/fsurg.2022.908745 . 35860199 . 9289604 . 2296-875X. free .

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