Erce Güler, Demet Doğan
Journal: Medpeer Publisher
ISSN: 3066-2737
Volume: 3
Issue: 7
Date of Publication: 2026/07/07
Dural ectasia is abnormal enlargement of the dural sac and may occur with connective tissue disorders, neurocutaneous syndromes, skeletal abnormalities, or no identifiable systemic disease. Its MRI appearance may overlap with perineural/Tarlov cysts and nerve root sleeve dilatations. This case cluster presents three female patients with different MRI patterns of generalized dural sac enlargement and associated perineural/Tarlov-type cystic dilatations, emphasizing morphologic assessment, quantitative measurements, and cautious clinical correlation. Case 1 was a 26-year-old woman with clinical suspicion for a Marfan-spectrum connective tissue disorder. Lumbar MRI showed marked cystic lumbosacral dural ectasia, with dural sac diameters of 30 mm at S1 and 18.5 mm at L4, yielding an S1/L4 ratio of 1.62. Case 2 was a 43-year-old woman with neck, shoulder, low back, and lower extremity pain. MRI showed mild generalized dural sac prominence and a dominant left S1 perineural/Tarlov-type cystic dilatation measuring 34 × 22 mm, with radiological nerve root compression but normal neurological and electrophysiological findings. Case 3 was a 55-year-old woman with low back pain and minimal right quadriceps weakness. MRI showed mild dural sac prominence, with S1/L4 diameters of 14/12 mm, and a right posterolateral L4 cystic lesion causing mild adjacent nerve root compression. Generalized dural sac enlargement and perineural/Tarlov-type cystic dilatations may coexist and create diagnostic pitfalls. Structured MRI assessment should distinguish generalized dural sac enlargement from focal cystic lesions and interpret symptoms cautiously when degenerative spinal disease coexists.
Dural ectasia, Perineural cyst, Tarlov cyst, Magnetic resonance imaging, Marfan syndrome
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