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Dural tumors made easy (radiology)

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  • 1. DURAL TUMOURS. Dr. NIKRISH S HEGDE
  • 2. MENINGIOMA Most common tumor to originate from the meninges.  Most common non glial primary brain tumor. M:F 1:2 ; 40 – 60 yrs
  • 3. HISTOLOGY. Meningothelial cells. Specialised meningothelial cells known as arachnoid cap cell. Few arise from dural fibroblasts. Choroid plexus and Arachnoid associated with cranial nerves.
  • 4. CYTOGENETIC. Chromosome 22 Neurofibromatosis type 2
  • 5. Related to sex hormones. Common in women, correlated with breast cancer and increase in size in pregnancy. Hormonal receptors.
  • 6. GROSS Globose : spherical or lobulated Enplaque: flat , carpet like infiltrative lesion. Sessile / Pedunculated
  • 7. CLASSIC DESCRIPTION Syncytial Fibrous Transitional Angioblastic
  • 8. WHO CLASSIFICATION Benign Atypical Anaplastic
  • 9. LOCATION Extra axial dural based lesions. Majority are supratentorial Dural venous sinuses, confluence of cranial sutures & arachnoid granulations.
  • 10. Parasagittal 25% Convexity 20% Sphenoid ridge 20% Olfactory 5% Para sellar 5% Posterior fossa 10%
  • 11. C/F Asymptomatic 10% symptomatic Depends on the locations
  • 12. Hemiparesis and seizures Visual field defects Multiple cranial nerve palsies Anosmia
  • 13. IMAGING Plain Film Angiography CT MRI
  • 14. PLAIN FILM Bone erosions Hyperostosis Tumoral calcifications Enlarged Vascular channels
  • 15. ANGIOGRAPHY Dual supply Centrally – Sunburst Pattern & peripherally by pial branches Late phase – mother in law sign
  • 16. CT Well circumscribed lobulated mass Abuts the dural surface at obtuse angle. Majority are hyperdense Calcification and bone destruction Edema
  • 17. NECT 90% homogenous enhancement 5-10% rim like enhancement  Inhomogeneous enhancementmushrooming
  • 18. MRI CSF cleft Displaced grey white matter interface 4 th ventricle compressed Ipsilateral CPA Cistern enlarged
  • 19.  T1 - isointense: ~ 60-90% somewhat hypointense: ~ 10-40% compared to grey matter
  • 20. T2 isointense: ~ 50% hyperintense: ~ 35-40% very hyperintense lesions may represent the microcystic variant 12 hypointense: ~ 10-15% compared to grey matter
  • 21. T1 C+ (Gd) - usually intense and homogenous enhancement. Moderate to severe peritumoral edema. Dural tail sign.
  • 22. DURAL TAIL SIGN occurs as a result of thickening of the dura
  • 23. 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
  • 24. HEMANGIOPERICYTOMA “Uncertain origin” Well circumscribed lesions Highly Vascular.
  • 25. 40-60 yrs Male preponderance Show recurrences and extra neural metastasis.
  • 26. ANGIOGRAPHY Hypervascular Heterogeneous tumor stain Dual Supply
  • 27. CT NECT – Heterogeneous CECT – Heterogeneous enhancement Cystic and necrotic areas
  • 28. MRI Extra axial T1 – Iso PD – Hyper T2 - Hetero Shows inhomogenous enhancement.
  • 29. MELANOCYTOMA Benign tumours. Leptomeningeal melanocytes. Locations - Foramen magnum, the posterior fossa, Meckel’s cave, or adjacent to cranial nerve nuclei.
  • 30. C/F 4th – 5th decade Size & Location. Pain , weakness & sensory defecits.
  • 31. CT NECT - hyper well defined lesion  CECT – Homogeneous enhancement.
  • 32. MRI T1 : isointense or hyperintense T2 : isointense or hypointense T1 C+ (Gd) : heterogenous enhancement T2* GRE : may show blooming of low signal
  • 33. DURAL METS  solid tumours  lung cancer  breast cancer  melanoma  haemopoietic neoplasms  lymphoma  leukaemia
  • 34. CT
  • 35. MRI
  • 36. THANK YOU 