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Pachymeningeal enhancement—a comprehensive review of literature

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Abstract

Pachymeningeal enhancement, synonymous with dural enhancement, is a radiological feature best appreciated on a contrast-enhanced magnetic resonance imaging (MRI). The vasculature of the dura mater is permeable, facilitating avid uptake of contrast agent and subsequent enhancement. Thin, discontinuous enhancement can be normal, seen in half the normal population. In patients complaining of postural headaches worse on sitting, gadolinium-enhanced MRI findings of diffuse pachymeningeal enhancement is highly suggestive of benign intracranial hypotension. In these cases, the process of pachymeningeal enhancement is explained by the Monro–Kellie doctrine as compensatory volume changes by vasocongestion and interstitial oedema of the dura mater due to decreased cerebrospinal fluid (CSF) pressure. Focal and diffuse pachymeningeal enhancement can also be attributed to infectious or inflammatory, neoplastic and iatrogenic aetiologies. Correction of the underlying pathology often results in spontaneous resolution of the pachymeningeal enhancement. There have also been reports of pachymeningeal enhancement associated with cerebral venous sinus thrombosis, temporal arteritis, baroreceptor reflex failure syndrome and arteriovenous fistulae.

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Author information

Author notes

  1. Joyce Antony

    Present address: The Royal Brisbane and Women’s Hospital, Herston, Queensland, 4006, Australia

Authors and Affiliations

  1. Kenneth G. Jamieson Neurosurgical Unit, The Royal Brisbane and Women’s Hospital, Herston, Australia

    Joyce Antony & Rosalind L. Jeffree

  2. School of Medicine, The University of Queensland, Brisbane, Australia

    Joyce Antony & Rosalind L. Jeffree

  3. The Royal Brisbane and Women’s Hospital, Herston, Queensland, 4006, Australia

    Craig Hacking & Rosalind L. Jeffree

  4. Department of Radiology, Melbourne, Victoria, 3050, Australia

    Craig Hacking

Authors
  1. Joyce Antony
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  2. Craig Hacking
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  3. Rosalind L. Jeffree
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Corresponding author

Correspondence to Joyce Antony.

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Comments

George Alexiou, Ioannina, Greece

This well-written and interesting article deals with the pachymeningeal enhancement from a neurosurgical perspective. The authors nicely point out the normal appearance of the dura, explain the role of the blood–brain barrier and vascularity and discuss the variations of pathological pachymeningeal enhancement patterns. Common pathological conditions, with these imaging findings, such as infections, malignancies and autoimmune disorders are nicely presented, and the authors provide clues to distinguish the different pathologic processes in the brain and meninges. They have provided us with a very helpful overview about the current concepts, which is also very well illustrated.

Sönke Langner, Greifswald, Germany

Dural or pachymeningeal enhancement seen on MR images obtained after contrast medium administration can be a normal imaging finding or an indicator of an underlying intracranial pathology. Precise knowledge of normal and abnormal enhancement patterns is the key to the correct interpretation of images and subsequent patient management. In their review, Antony et al. describe the normal MR appearance of the dura and typical patterns of abnormal enhancement. The authors cover a wide spectrum of abnormal conditions ranging from tumours to infectious diseases. The underlying diseases are discussed in light of the recent literature and thoroughly illustrated by images. This review will assist radiologists in image interpretation in the daily clinical setting and facilitate communication with other medical specialities and patient management.

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Antony, J., Hacking, C. & Jeffree, R.L. Pachymeningeal enhancement—a comprehensive review of literature. Neurosurg Rev 38, 649–659 (2015). https://doi.org/10.1007/s10143-015-0646-y

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  • DOI: https://doi.org/10.1007/s10143-015-0646-y

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