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Outline
Meninges
of the Ø Anatomy of the meninges

Brain and Spine Ø Enhancement

Ø Techniques

Majda M Thurnher
Ø Pathology of meninges
Medical University of Vienna | University Hospital Vienna
Department of Biomedical Imaging and Image-Guided Therapy
Vienna | Austria

CEO of the European Board of Neuroradiology (EBNR)

Past President of the European Society of Neuroradiology (ESNR)

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THE MENINGES THE DURA MATTER

„ the hard mother“
• Membranous
coverings of the • thick, dense, fibrous and INELASTIC membrane
brain and spinal • composed of two layers:
cord a) the periosteal layer that lies closest to the
calvarium
• Three layers: dura b) the meningeal layer that lies closest to the brain
mater, arachnoid tissue
mater, pia mater
• Mostly fused (except for the dural sinuses)
• Two major functions:
- Provide a supportive framework for the cerebral and cranial vasculature
- Act with cerebrospinal fluid to protect the CNS from mechanical damage

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THE DURA MATTER THE DURAL INFOLDINGS (processes)

„ the hard mother“

• The dura mater receives its own vasculature; primarily from the FALX CEREBRI
middle meningeal artery and vein
TENTORIUM CEREBELLI
• It is innervated by the trigeminal nerve (V1, V2 and V3)
FALX CEREBELLI
• Lacks the blood-brain barrier (BBB)
DIAPHRAGMA SELLAE
• In some areas within the skull, the meningeal layer of the
dura mater folds inwards as DURAL REFLECTIONS. They
partition the brain, and divide the cranial cavity into
several compartments. Dural reflections refer to places where two face-to-face meningeal layers descend
into the cranial cavity to form the septa that compartmentalize the brain.

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FALX CEREBRI
• The largest infolding

• in the longitudinal cerebral

fissure, which divides the two
hemispheres of the cerebrum

• relatively thin anteriorly where it

attaches to the crista galli

• broader posteriorly where it

attaches to the superior
surface of the tentorium
cerebelli inferiorly

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DIAPHRAGMA SELLAE TENTORIUM CEREBELLI

• Small circular fold of dura mater that forms the roof for
the pituitary gland
• A small opening in its center allows passage of the stalk of
the pituitary gland

• The “U” shaped tentorium cerebelli runs transversely

between the cerebellum and occipital lobes.

• There is an opening in the falx cerebri, known as the

tentorial incisura (sometimes referred to as the
tentorial notch), that allows the midbrain to pass
through into the middle cranial fossa.

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DURAL VENOUS SINUSES THE ARACHNOID MATTER

• Venous channels located intracranially between the two layers of dura „ the spidery mother“
matter

• the middle layer of the meninges, lying directly

underneath the dura mater

• It consists of layers of connective tissue

• Thin, lucent membrane

• avascular
• does not receive any innervation

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THE SUB-ARACHNOID SPACE

• Underneath the arachnoid is a space known as the sub-arachnoid space
• It contains cerebrospinal fluid

• Small projections of arachnoid mater into the dura (ARACHNOID GRANULATIONS)

allow CSF to re-enter the circulation via the dural venous sinuses

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Arachnoid granulations (Pacchionian granulation)

• They most frequently occur in a parasagittal location with the

sinus transversus and superior sagittal sinus being the most
common locations.

• incidental osteolytic, sharply

circumscribed indolent-appearing • On MRI a filling defect in dural venous
lucencies on skull CT sinuses, which can be mistaken for SVT

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THE PIA MATER

„ the delicate mother“

• located underneath the sub-arachnoid space

• It is very thin and tightly adhered to the surface of the brain

and spinal cord, it is the only covering to follow the contours
of the brain (the gyri and fissures)

• It is highly vascularized, with blood vessels perforating

through the membrane to supply the underlying neural tissue

• Two layers:
a) epipial layer – connects to the arachnoid matter
b) intima pia – connects to the neural tissue
Leptomeninges = arachnoid + pia

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THE PERIVASCULAR SPACES SPINAL MENINGES

• Three layers of meninges envelop the spinal cord and
the roots of spinal nerves

Dura mater

Arachnoid

Pia mater

• the pia mater forms sheaths around the blood vessels that enter and exit the
brain perpendicular to the meninges, specifically from the subarachnoid space Leptomeninges
to within the brain parenchyma

• This sheathing creates an interstitial fluid-filled space, known as the

perivascular or Virchow-Robin space, between the vessel walls and the pia

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THE SPINAL DURA MATER

• Around the margin of the foramen magnum cranial dura
mater is closely adherent to the bone, and is continuous
with the spinal dura mater

• The Spinal Dura Mater (dura mater spinalis) forms a loose

sheath around the medulla spinalis

• represents only the meningeal layer of the cranial dura mater

(the endosteal layer ceases at the foramen magnum)

• its place is taken by the periosteum lining the vertebral canal

Spinal dura mater is thicker and less vascular than cranial

dura mater

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SPINAL SPACES

EPIDURAL SPACE:
between dura and periosteum
• Fat
• Internal vertebral venous plexus
• Spinal nerve roots below S2

SUBDURAL SPACE
between arachnoid and pia
• Arachnoid trabeculae
• CSF
• Arteries
• Veins

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Internal vertebral venous plexus

• It sits within the spinal canal within a layer of fat
containing the internal vertebral venous plexus.
• The vertebral venous plexus is a highly
anastomotic network of valveless veins running
along the entire length of the spinal canal.

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Subdural hematoma Epidural hematoma

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Embryology of the meninges BLOOD SUPPLY

Dura:
• The major arteries that supply the dura are derived from the internal carotid,
• The dura mater is derived from the mesoderm, vertebral, maxillary, ascending pharyngeal, lacrimal, occipital, and ethmoidal
• The arachnoid and pia mater are derived from the arteries.
ectoderm
• Of the arteries that supply the dura, the middle meningeal artery (MMA), which
branches from the internal carotid artery’s maxillary branch, is the most important
• Specifically, the development of the meninges begins with
what is known as the perimedullarly mesenchyme, which
contains cells from both the ectoderm and mesoderm Arachnoid: avascular

• The leptomeninges forms first, as cells from the neural

crest differentiate into the pia and arachnoid Pia: highly vascularized, small cappilaries

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SPACES

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Normal dural enhancement

Outline

Ø Anatomy of the meninges

Ø Enhancement
Ø Techniques

Ø Pathology of meninges • On T1-weighted MR images: normal dura mater and inner

table bone are uniformly hypointense
• After contrast normal dura shows thin, linear, and
discontinuos enhancement (variable thickness)

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Pachymeningeal enhancement pattern

Enhancement pattern
Dura-arachnoid enhancement

a) Pachymeningeal enhancement pattern

Dura-arachnoid enhancement

b) Pia-subarachnoid enhancement pattern

Leptomeningeal enhancement

Dural and outer layer of arachnoid pattern of

enhancement!

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Pia-subarachnoid enhancement pattern Enhancement pattern

Leptomeningeal enhancement
Pachymeningeal Pia-subarachnoid
enhancement enhancement
Dura-arachnoid enhancement Leptomeningeal enhancement

Intracranial hypotension Meningitis (bacterial, viral, fungal)

Transient postoperative changes Carcinomatous meningitis
Granulomatous disease
Meningioma
Enhancement of sulci and subarachnoid spaces Metastatic disease
Follows the pial surface of the brain and fills the subarachnoid spaces of the Lymphoma
sulci and cisterns

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Pachymeningeal enhancement
Intracranial hypotension
Dura-arachnoid enhancement

Hypotension Meningioma Metastatic disease

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Pia-subarachnoid enhancement
Leptomeningeal enhancement Enhancement pattern

Pachymeningeal Pia-subarachnoid
enhancement enhancement
Dura-arachnoid enhancement Leptomeningeal enhancement

Thin, linear enhancement Thick, lumpy, nodular

Tuberculous meningitis

Meningitis (bacterial, viral, fungal) Carcinomatous meningitis

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Meningitis

Pia-subarachnoid enhancement Pia-subarachnoid enhancement

Thin, linear Thick, nodular

Tuberculous meningitis Metastatic disease

Metastatic disease

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Enhancement pattern
Meningitis

Pachymeningeal enhancement Pia-subarachnoid enhancement

Thin, linear enhancement Thick, lumpy, nodular

bilateral, diffuse unilateral

Carcinomatous meningitis

Meningitis IgG-related pachymeningitis

(bacterial, viral, fungal) Sturge-Weber syndrome
Neurosarcoidosis
Vasculitis Vasculitis Sarcoidosis IgG- related pachymeningitis

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CE-FLAIR
Outline

Ø Anatomy of the meninges

Ø Enhancement
Ø Techniques

Ø Pathology of meninges

CE-T1WI

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CE-FLAIR

CE-T1WI CE-FLAIR
CE-T1WI

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CE-T1WI CE-FLAIR

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Outline

Ø Anatomy of the meninges

Ø Enhancement
Infection

Ø Techniques

Ø Pathology of meninges

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Meningitis
Meningitis Imaging Findings
Inflammatory infiltration of PIA, ARACHNOID, and CSF
• Acute pyogenic (bacterial)
• High FLAIR signal of CSF spaces
• Lymphocytic (viral)
• Dural/meningeal enhancement
• Chronic (TB or granulomatous)
• Hydrocephalus
• Subdural effusions/empyema
• Venous & arterial infarcts
• DWI high signal in VR Spaces

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• High FLAIR signal of CSF spaces

Congestion and hyperemia of the leptomeninges with exudates in
the subarachnoid space (high protein content in subarachnoid
spaces)

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• Infarcts

• Subdural effusions

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• Debris level

• Leptomeningeal enhancement

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Inflammation

• DWI: high signal in subarachnoid spaces

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IgG4-related pachymeningitis Ig G4-related pachymeningitis

• Rare manifestation of IgG4 related fibroinflammatory • Inflammation leading to a localized or diffuse
disease spectrum thickening of the meninges overlying the
supratentorial hemispheres, skull base, or spinal cord
• Autoimmune pancreatitis
Mikulicz disease • Symptoms related to mass effect or focal deficits
Pseudotumor of the lung IgG4-related disease caused by the compression of blood vessels or
Tubulointerstitial nephritis (IgG4-RD) nerves
Riedel thyroiditis
• CT: Bone involvement
• CNS involvement is rare, most common CNS manifestation • MRI: Linear/ mass forming, T2: relatively hipointens,
is hypophysitis T1+ Gd: contrast enhancement

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Boban J, Ardali S, Thurnher M. Neuroradiology 2018

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Courtesy of Andrea Rossi/IT

Anti-GQ1b antibody syndrome

1. Bickerstaff Brain Stem Encephalitis (BBE) Miller-Fisher Syndrome
2. Miller-Fisher Syndrome (GBS Variant)
3. Acute Ophtalmoparesis

• inflammatory non-infectious origin and specifically to be

an autoimmune disease

• immune cross-reaction seems to be triggered by previous 6 th nerve

exposure to Campylobacter Jejuni and Mycoplasma

pneumoniae

• Different CNS phenotypes 7 th nerve 3 rd nerve

5 th nerve

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Sarcoidosis
• Granulomatous disease
• Unknown etiology
• Young adults

Neurosarcoid (in 5%)

• Solitary or multifocal CNS masses
• Dural (30-50%), meningeal (30%)
• Optic chiasm, hypothalamus, infundibulum
• Cranial nerves
• Spine

Abnormal Chest x-ray in 90%

Courtesy P Sundgren / SE

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Vasculitis

Neoplastic

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Metastatic disease

Meningeal
Sarcoma

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Metastatic disease
Differential

Infection Infection Inflammatory drug toxicity

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Metastatic disease Lymphoma

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Thank you

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