Dural metastases
Updates to Article Attributes
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 focussed 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 4. A significant number (~20%) may be clinically occult.
Pathology
There are four mechanisms by which intracranial dural metastases are thought to occur 2:
- direct extension from skull metastases
- retrograde seeding through the vertebral venous plexus
- haematogenous seeding
- lymphatic seeding
The primary malignancies that frequently cause dural metatasesmetastases include (in descending order of frequency) 1,2:
- breast cancer
- prostate cancer
- lung cancer
- head and neck cancers
- haematological cancers
- neuroblastoma
Radiographic features
MRI
Dural metastases may be diffuse or present as a focal mass. Typically multiple lesions.
Signal characteristics
- T1: typically iso/hypointense to adjacent cortex
- T2: iso/hyperintense to adjacent cortex
- T1C+: vivid enhancement 4
-
MRS
- choline/creatine ratio 5
- prominent lipid peak 5
- occasional lactate peak 5
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
peakandpeak and no lipid/lactate peak - haemangiopericytoma: 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 / immunocompromised patients
- neurosarcoidosis: multifocal dural based masses; leptomeningeal enhancement; no skull involvement; abnormal chest x-ray and serum markers
- chronic subdural haemorrhage: 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.
-</ul><p>The primary malignancies that frequently cause dural metatases include (in descending order of frequency) <sup>1,2</sup>:</p><ul>- +</ul><p>The primary malignancies that frequently cause dural metastases include (in descending order of frequency) <sup>1,2</sup>:</p><ul>
-</ul><h4>Radiographic features</h4><h5>MRI</h5><p>Dural metastases may be diffuse or present as a focal mass. Typically multiple lesions.</p><h6>Signal characteristics</h6><ul>- +</ul><h4>Radiographic features</h4><h5>MRI</h5><p>Dural metastases may be diffuse or present as a focal mass. Typically multiple lesions.</p><h6>Signal characteristics</h6><ul>
-<a href="/articles/meningioma">meningiomas</a>: can look indistinguishable; dural based mass with "dural tail", hyperostosis and calcification; MRS: increased alanine peakand no lipid/lactate peak</li>- +<a href="/articles/meningioma">meningiomas</a>: can look indistinguishable; dural based mass with "dural tail", hyperostosis and calcification; MRS: increased alanine peak and no lipid/lactate peak</li>
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