River Y, Schwartz A, Gomori J M, Soffer D, Siegal T
Department of Neurology, Hadassah-Hebrew University Hospital, Jerusalem, Israel.
J Neurosurg. 1996 Nov;85(5):777-83. doi: 10.3171/jns.1996.85.5.0777.
This study was performed to determine the clinical significance of diffuse dural enhancement (DDE) detected by magnetic resonance (MR) imaging and to typify enhancing patterns related to inflammatory or metastatic causes. The authors retrospectively evaluated the clinical, imaging, and laboratory characteristics of 20 consecutive patients with DDE. Those with DDE and an underlying neoplastic disease (13 patients) were compared to 11 consecutive patients with cytological evidence of neoplastic leptomeningeal metastasis evaluated by MR imaging. The DDE was often associated with an underlying malignancy (13 (65%) of 20 patients) but it coexisted with leptomeningeal metastasis in only one patient. Skull metastases were evident in 10 (77%) of 13 patients and cranial nerve palsies in six (46%) of 13. Other causes of DDE were related to cerebrospinal fluid (CSF) leak or shunting (five (25%) of 20), with or without symptoms of intracranial hypotension, and to dural sinus thrombosis and pachymeningitis. Dural biopsies obtained in two patients with DDE showed a narrow rim of granulation-like tissue adherent to the dural surface facing the inner skull table. Magnetic resonance subtraction, diffusion, and perfusion studies revealed unique characteristics in patients with metastatic causes as compared to those with DDE secondary to CSF leak. None of the patients with proven leptomeningeal metastasis had DDE, but four of them presented with focal dural enhancement and two displayed apparent leptomeningeal enhancement. The findings indicate that DDE is not a radiographic hallmark of leptomeningeal metastasis in spite of the similarities in clinical manifestations (for example, headache and cranial polyneuropathy). Nonetheless, DDE is most frequently associated with metastatic malignancies and particularly with skull metastases and CSF leak. Special MR techniques can discern the underlying cause and elucidate the disparity in the pathophysiological mechanisms leading to DDE.
本研究旨在确定磁共振成像（MR）检测到的弥漫性硬脑膜强化（DDE）的临床意义，并对与炎症或转移原因相关的强化模式进行分类。作者回顾性评估了20例连续DDE患者的临床、影像和实验室特征。将有DDE且患有潜在肿瘤性疾病的患者（13例）与11例通过MR成像评估有肿瘤性软脑膜转移细胞学证据的连续患者进行比较。DDE常与潜在恶性肿瘤相关（20例患者中有13例（65%）），但仅1例患者同时存在软脑膜转移。13例患者中有10例（77%）有颅骨转移，13例中有6例（46%）有脑神经麻痹。DDE的其他原因与脑脊液（CSF）漏或分流有关（20例中有5例（25%）），伴有或不伴有颅内低压症状，以及与硬脑膜窦血栓形成和硬脑膜炎有关。在2例DDE患者中获取的硬脑膜活检显示，在面向颅骨内板的硬脑膜表面有一层狭窄的颗粒样组织附着。与CSF漏继发的DDE患者相比，磁共振减影、扩散和灌注研究显示转移原因患者具有独特特征。经证实有软脑膜转移的患者均无DDE，但其中4例出现局灶性硬脑膜强化，2例表现为明显的软脑膜强化。这些发现表明，尽管临床表现有相似之处（如头痛和颅神经多神经病），但DDE并非软脑膜转移的影像学特征。尽管如此，DDE最常与转移性恶性肿瘤相关，尤其是与颅骨转移和CSF漏相关。特殊的MR技术可以识别潜在原因，并阐明导致DDE的病理生理机制差异。
