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Unformatted text preview: Eric W. Wallace, MD The Dural Tail Sign 1 APPEARANCE The dural tail sign is seen on contrast materialenhanced mag- netic resonance (MR) images as a thickening of the enhanced dura mater that resembles a tail extending from a mass (Figs 1, 2). EXPLANATION Precise pathophysiologic understanding of the dural tail typi- cally associated with meningioma is less than complete. It was initially proposed that dural tails resulted from direct tumor invasion (1), but many later investigators (2,3) were able to show little or no direct tumor involvement. It was therefore proposed that dural tails represented reactive changes to the dura mater, with perhaps minimal changes to meningothelial nodules that were adjacent to but not in contiguity with the tumor. Meningiomas are known to be hypervascular, which results in additional adjacent reactive changes such as hyper- ostosis and sinus blistering (4). It is reasonable that both mech- anisms (tumor invasion and hypervascular reaction) may be responsible for the dural tail sign. DISCUSSION An early clinical description of meningioma was reported in 1614 (5). Unfortunately, at that time the diagnosis could be made only after death. In 1902, George E. Pfahler, MD, then a resident physician, was able to offer a radiologic diagnosis on a living patient. Pfahler described the tumor shadow of a meningioma on conventional radiographs (5). In 1989, Wilms et al (1) described dural tails that were associated with menin- giomas on MR images....
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- Spring '09