Aus den Archiven für Radiologische Pathologie^[1] – Tumoren der Dura: zur Differenzialdiagnose des Meningeoms – Korrelation zwischen radiologischen und pathologischen Befunden^[2]

 

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Zusammenfassung

Der häufigste Tumor mit Durabeteiligung ist das Meningeom; bei der differenzialdiagnostischen Abklärung aller durabasierten Tumoren steht es daher immer an erster Stelle. Es gibt jedoch eine ganze Reihe anderer neoplastischer und nicht neoplastischer Läsionen, an denen die Dura ebenfalls beteiligt ist. Aus der Kenntnis der Anatomie der Dura lassen sich Hinweise auf die verschiedenen Prozesse gewinnen, die sich an dieser Lokalisation abspielen können. Bei den neoplastischen Prozessen handelt es sich teils um benigne, teils um maligne Läsionen: Hämangioperizytome, Lymphome, solitäre fibröse Tumoren, melanozytäre Läsionen, Epstein-Barr-Virus-assoziierte Tumoren der glatten Muskulatur, Manifestationen der Rosai-Dorfman-Krankheit und Metastasen. Als nicht neoplastische Prozesse sind infektiöse und entzündliche Entitäten, wie Tuberkulose und Sarkoidose, zu nennen, die Tumoren sehr ähnlich sein können. In manchen Fällen entwickeln sich Neoplasien, wie z. B. Gliosarkome, an der Peripherie des Hirnparenchyms, sodass der Anschein erweckt wird, sie gingen von der Dura aus und hätten sogar einen Duraausläufer (sog. Dural Tail). Viele dieser Läsionen weisen in der bildgebenden Darstellung mittels CT, MRT und Angiografie Gemeinsamkeiten mit den Meningeomen auf, z. B. einen Dural Tail, eine vermehrte Gefäßversorgung, prompte Kontrastmittelanreicherung und Ähnlichkeiten der Signalcharakteristika. Alter, Geschlecht und Grundkrankheiten des Patienten sowie bestimmte Besonderheiten im Bildgebungsbefund ermöglichen jedoch wichtige Rückschlüsse auf die Art der Läsionen. So sollte beispielsweise bei der Differenzialdiagnose durabasierter Läsionen bei HIV-infizierten Personen (Personen mit Infektion durch das humane Immundefizienzvirus) auch an die Epstein-Barr-Virus-assoziierten Tumoren der glatten Muskulatur gedacht werden. Das chirurgische Vorgehen bei den einzelnen Läsionen ist verschieden und ebenso die Prognose. Die Kenntnis der unterschiedlichen Läsionen, die die Dura betreffen, ihrer Bildgebungsbefunde und ihrer klinischen Merkmale hilft bei der Eingrenzung der radiologischen Differenzialdiagnose und bei der Optimierung der Therapie.

Abstract

Meningioma is the most common mass involving the dura, making it number one in the differential diagnosis for any dural-based mass; however, a variety of other neoplastic and nonneoplastic lesions also involve the dura. Knowledge of the dural anatomy can provide clues to the various processes that may involve this location. The neoplastic processes include both benign and malignant lesions such as hemangiopericytoma, lymphoma, solitary fibrous tumor, melanocytic lesions, Epstein-Barr virus-associated smooth muscle tumors, Rosai-Dorfman disease, and metastatic lesions. The nonneoplastic processes include infectious and inflammatory entities such as tuberculosis and sarcoid, which may mimic mass lesions. In some cases, neoplasms such as gliosarcoma may arise peripherally from the brain parenchyma, appearing dural-based and even inciting a dural tail. Many of these share similar computed tomographic, magnetic resonance imaging, and angiographic characteristics with meningiomas, such as a dural tail, increased vascularity, avid enhancement, and similar signal characteristics; however, knowledge of the patient’s age, gender, and underlying conditions and certain imaging characteristics may provide valuable clues to recognizing these lesions. For example, in the population with human immunodeficiency virus infection, Epstein-Barr virus-associated smooth muscle tumors should be included in the differential diagnosis for dural-based lesions. The surgical course and prognosis for these lesions vary, and knowledge of the variety of lesions that involve the dura, their imaging appearances, and their clinical features assists in narrowing the radiologic differential diagnosis and optimizing patient treatment.

¹ mit Unterstützung des American Institute for Radiologic Pathology (AIRP), des Joint Pathology Center (JPC) und der Uniformed Services University of the Health Sciences (USU)

^{2 ©} 2014 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2014; 34: 295 – 312. Online published in 10.1148 /rg.342130075. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.

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