Assessment of dural involvement in calvarial and skull base fibrous dysplasia - 03/11/25

Doi : 10.1016/j.neuchi.2025.101744

Elif Gozgec ^a,⁎ , Hayri Ogul ^b, Ahmet Tugrul Akkus ^a, Muhammed Furkan Barutcugil ^a
^a Department of Radiology, Ataturk University School of Medicine, Erzurum, Turkey
^b Department of Radiology, Medipol University, Istanbul, Turkey

^⁎Corresponding author at: The Hospital of Ataturk University, Department of Radiology, Erzurum, Turkey.The Hospital of Ataturk UniversityDepartment of RadiologyErzurumTurkey

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Highlights

•	Dural contrast enhancement was observed in 59% of fibrous dysplasia (FD) cases, particularly in skull base and temporal bone lesions.
•	Strong correlation found between inner table destruction and dural enhancement (p = 0.01), suggesting a possible inflammatory mechanism.
•	Lesion size was not significantly associated with dural enhancement.
•	MRI plays a crucial role in identifying dural involvement, which may help guide treatment decisions and prevent unnecessary surgeries.
•	The study proposes that inflammatory processes, possibly linked to IL-6 upregulation, may contribute to dural enhancement.

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Abstract

Objectives

Neurogenic symptoms in craniofacial fibrous dysplasia (FD) are typically caused by direct compression due to the lesion's expansile nature. However, in rare cases, atypical symptoms unrelated to direct compression and associated dural contrast enhancement have been reported. The aim of this study was to investigate the relationship between FD and adjacent dural contrast enhancement.

Material and Methods

This observational study included patients with FD localized to the skull base or calvarium. The location of the lesion, its axial dimensions, and the presence of destruction of the inner table were determined on CT images. On contrast enhanced cranial MR imaging, the presence of dural enhancement was evaluated. The relationship between dural enhancement and other parameters was statistically analyzed.

Results

Of the 27 patients included in the study, 15 were female. Dural contrast enhancement was detected in 16 cases. It was higher in skull base localization than in calvarial localization. Fibrous dysplasia was most commonly localized in the frontal bones, with the highest rate of concomitant dural contrast enhancement in the temporal bone (100%). There was a significant correlation between dural contrast enhancement and inner table destruction. There was no correlation between the size of the lesions and dural contrast enhancement.

Conclusions

MRI findings suggest that FD is frequently associated with dural contrast enhancement, particularly in cases with inner table destruction. This may contribute to neurogenic symptoms and influence treatment strategies. Understanding this association may aid in determining optimal management and avoiding unnecessary surgical interventions.

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Keywords : Fibrous dysplasia, Craniofacial, Skull base, Calvarium, MR imaging, CT imaging