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DOI: 10.1148/rg.254045207
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Right arrow Neuroradiology

Idiopathic Tumefactive Hypertrophic Pachymeningitis1

Imran A. Kazem, MD, Natasha L. Robinette, MD, Norbert Roosen, MD, Michael F. Schaldenbrand, MD and Joon K. Kim, MD

1 From the Department of Radiology, Oakwood Healthcare System, 18101 Oakwood Blvd, Dearborn, MI 48124. Received December 1, 2004; revision requested January 10, 2005 and received February 21; accepted February 25. All authors have no financial relationships to disclose.


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  		Figure 1.  Coronal gadolinium-enhanced T1-weighted MR image reveals a large, lobulated right frontal lobe mass with an adjacent satellite lesion (arrow). Dural thickening and enhancement are seen along the frontal lobes and anterior falx (arrowheads).

 


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  		Figure 2a.  (a) Axial T1-weighted MR image shows the mass (*) to be isointense relative to gray matter. There is midline shift to the left (arrow), with mass effect on the right lateral ventricle and the frontal horn of the left lateral ventricle (arrowheads). (b) On an axial T2-weighted MR image, the mass is again isointense relative to gray matter and contains scattered hyperintense foci. (c) Axial fluid-attenuated inversion recovery MR image demonstrates vasogenic white matter edema (arrows). Transependymal cerebral spinal fluid flow is seen adjacent to the occipital horn of the left lateral ventricle (arrowhead).

 


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  		Figure 2b.  (a) Axial T1-weighted MR image shows the mass (*) to be isointense relative to gray matter. There is midline shift to the left (arrow), with mass effect on the right lateral ventricle and the frontal horn of the left lateral ventricle (arrowheads). (b) On an axial T2-weighted MR image, the mass is again isointense relative to gray matter and contains scattered hyperintense foci. (c) Axial fluid-attenuated inversion recovery MR image demonstrates vasogenic white matter edema (arrows). Transependymal cerebral spinal fluid flow is seen adjacent to the occipital horn of the left lateral ventricle (arrowhead).

 


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  		Figure 2c.  (a) Axial T1-weighted MR image shows the mass (*) to be isointense relative to gray matter. There is midline shift to the left (arrow), with mass effect on the right lateral ventricle and the frontal horn of the left lateral ventricle (arrowheads). (b) On an axial T2-weighted MR image, the mass is again isointense relative to gray matter and contains scattered hyperintense foci. (c) Axial fluid-attenuated inversion recovery MR image demonstrates vasogenic white matter edema (arrows). Transependymal cerebral spinal fluid flow is seen adjacent to the occipital horn of the left lateral ventricle (arrowhead).

 


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  		Figure 3a.  (a) Axial gadolinium-enhanced T1-weighted MR image reveals thickening and enhancement of the dura mater along the anterior and medial aspects of the temporal lobes (arrows). (b) Axial gadolinium-enhanced T1-weighted MR image shows enhancement of the mass and thickening of the dura mater in the frontal lobes, left temporal lobe, and falx (arrows). Leptomeningeal enhancement is noted in the medial left frontal lobe sulci (arrowhead).

 


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  		Figure 3b.  (a) Axial gadolinium-enhanced T1-weighted MR image reveals thickening and enhancement of the dura mater along the anterior and medial aspects of the temporal lobes (arrows). (b) Axial gadolinium-enhanced T1-weighted MR image shows enhancement of the mass and thickening of the dura mater in the frontal lobes, left temporal lobe, and falx (arrows). Leptomeningeal enhancement is noted in the medial left frontal lobe sulci (arrowhead).

 


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  		Figure 4.  Photograph of the resected dural mass shows the external surface of the mass to be lobulated and pink-yellow. The cut surface is also pink-yellow with minimal glistening.

 


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  		Figure 5a.  (a) Low-power photomicrograph (original magnification, x 40; hematoxylineosin stain) of the resected dural mass shows necrotizing (arrows) and nonnecrotizing (arrowheads) granulomas. (b) Higher-power photomicrograph (original magnification, x 100; hematoxylineosin stain) shows a necrotizing granuloma. Central caseous tissue necrosis is surrounded by fibrosis and numerous macrophages (dark blue).

 


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  		Figure 5b.  (a) Low-power photomicrograph (original magnification, x 40; hematoxylineosin stain) of the resected dural mass shows necrotizing (arrows) and nonnecrotizing (arrowheads) granulomas. (b) Higher-power photomicrograph (original magnification, x 100; hematoxylineosin stain) shows a necrotizing granuloma. Central caseous tissue necrosis is surrounded by fibrosis and numerous macrophages (dark blue).

 


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  		Figure 6.  Axial gadolinium-enhanced T1-weighted MR image obtained 2 months after resection shows linear dural enhancement along the frontal lobes and anterior falx (arrows). Postsurgical changes are seen in the right frontal lobe (*).

 


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  		Figure 7.  Axial gadolinium-enhanced T1-weighted MR image obtained 8 months after resection demonstrates recurrent nodular dural enhancement along the left temporal lobe (arrow).

 




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