Serviço de Neurorradiologia, Hospital Dona Estefânia e São José, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- XVI Congresso da SPNR Diagnóstica e Terapêutica, 19 e 20 novembro 2021, Lisboa
- Neuroradiology volume 64, pages1047–1076 (2022); doi.org/10.1007/s00234-022-02903-2
Introduction: Dural-based mass lesions comprise a variety of neoplastic and non-neoplastic lesions. Neoplastic entities are the most common and include both primary lesions (such as meningiomas) and dural metastases. Non-neoplastic lesions include granulomatous, autoimmune and idiopathic entities. The aim of this work is to provide a pictorial review of dural-based mass lesions based on illustrative cases from our institution, excluding typical meningiomas (WHO grade I) with common imaging features.
Methods: Our prospective database was screened from January 2017 to June 2021. Patients with histologically proven duralbased mass lesions were selected.
Results: We present 8 illustrative cases of dural-based mass lesions, of which 6 correspond to neoplastic entities and 2 to infectious lesions. Neoplastic lesions include hemangiopericytoma/solitary fibrous tumor of the meninges, primary dural lymphoma, lymphoplasmacyte-rich meningioma (WHO grade I) with significant peritumoral edema, anaplastic meningioma (WHO grade III), primary duralbased Ewing sarcoma and dural metastases from malignant melanoma. Infectious lesions include tuberculosis with dural tuberculomas and fungal mycetoma, the latter with compatible histological features but inconclusive blood cultures. In each case we describe the site of the lesion, presence/absence of the dural tail sign, presence/absence of vasogenic edema and the main imaging features on computed tomography (CT) and magnetic resonance (MRI) imaging techniques, in order to guide the differential diagnosis of dural-based mass lesions.
Conclusion: The differential diagnosis of dural-based mass lesions is extensive and includes a variety of neoplastic and nonneoplastic entities, besides typical meningiomas. A significant proportion of lesions may show similar imaging features. Therefore, clinical, laboratorial and histologic findings are important to establish the correct diagnosis and provide the best possible therapeutic approach.
Palavras Chave: differential diagnosis; dural masses; MRI;