Interdural high signal on CISS sequence: an alternative CSF pathway?

Purpose The falx cerebri, falx cerebelli, and tentorial notch exhibit a peculiar morphology with a two-layered, dural leaf that protrudes into the cranial cavity with a free edge. However, there are few studies exploring this morphology using neuroimaging techniques. The present study aimed to explore these dural structures using magnetic resonance imaging. Methods A total of 65 outpatients were included in this study. Following initial examinations with conventional sequences, the constructive interference in steady-state (CISS) sequences were performed in thin-sliced, coronal sections. Results In 78% of the subjects, the interdural spaces presenting with high signal were identified in the falx cerebri. These spaces were located adjacent to the uppermost part of the falx, formed by two dural leaves and the superior sagittal sinus, and tapered downward where the leaves united to form the falx cerebri. At the tentorial notch, these spaces were found in 52% of the 65, most predominantly in the medial edge followed by the tentorium cerebelli-tentorial notch junctional region. Forty-one percent of patients had a dural opening into the cerebral cistern. The interdural spaces with high signal were not identified in the tentorium cerebelli in any of the subjects. Conclusions The falx cerebri and tentorial notch form the interdural spaces that may provide alternative cerebrospinal fluid pathways. The coronal CISS sequence is suitable for delineating such interdural spaces.