Imaging of disease spread through the skull base
description
Transcript of Imaging of disease spread through the skull base
Imaging of disease spread through the skull base
Eufrozina SelariuSkåne Universitetssjukhus Malmö
Sweden
Characterisation of the lesion
Morphology 1. tissue characterisation 2. pattern of bone involvment 3. vascularity Localisation 1. intrinsic to the skull base 2. arrising from intracranial compartment 3. arrising from extracranial head and neck Invasion of other structures 1. Direct extension
• infiltrating bone, soft tissue, meninges, cerebrum• preformed channels and foramina
2. Hematogenous spread 3. Perineural spread
Glomus Jugulare Paraganglioma
Dural arteriovenous fistula
Bone involvement pattern
Agressive bone involvement pattern
Osteolysis Absent bone replaced by soft tissue Thinned bone with soft tissue mass
on its both sides Abnormal signal of the bone marrow Calcifications within the soft tissue
mass
Non-aggressive bone involvement pattern Bone remodeling with bowing, thin or demineralized walls Bone expansion with smooth contour or interrupted walls Enlarged intramedullary cavity Varying attenuation: ground-glass, radiolucent or sclerotic
Eosinophilic granuloma Clivus Chordoma
Juvenil Angiofibroma
Pituitary adenoma
Direct extensionby preformed pathways
EsthesioneuroblastomaOlfactorius meningioma
Trigeminal Neurofibroma
Sphenoid meningioma Optic nerve meningioma
Abscess MPS, PPS, MS, CS, RPS
Pharygeal mucosal space PMS Sinus Morgagni Parapharyngeal space PPS Skull base Carotid space CS Canalis caroticus Jugular foramen Mandibular space MS Foramen ovale Retropharyngeal space RPS Basiocciput
Direct extensionby infiltrating structures
Skull base Metastasis
Occur in bone with high marrow content
Osteoblastic metastasis Hypervascular metastasis Osteolytic metastasis
Frontal sinus Squamous Cell Carcinoma
Sinus frontalis Squamous Cell Cancer with intracranial spread
Nodular dural enhancing have high specificity
Dural thickness > 5 mm Coexistent leptomeningeal
enhancement Brain parenchymal changes
Hematogenous spread
Acute Mastoiditis – Local complications
Subperiosteal abscess Sinus thrombosis Bezold abscess Perisinus and epidural
abscess Petrositis Labyrintitis
Acute OtitisIntracranial complications
Cavernous sinus thrombosisEnlarged superior ophtalmic veinsExophtalmusInhomogenous enhancement of
cavernous sinus
Acute Otitis - Intracranial complications Subdural empyema
Meningitis Petrous apicitis
Perineural spread
Nerve enlargement and nerve enhancement Obliteration of the fat in the foramina, fosse or fissures Foraminal enlargement or destruction Enhancing soft tissue in the cavernous sinus and Meckel cave Neuropathic atrophy and fat replacement
Tumor growth
Incresed permeability of endoneurial capillaries Rupture of the blood-nerve barrier
Contrast-enhancement
Perineural spread
Blood-nerve barrier disruption with segmental nerve enhancement
Inflammation – neuritis Ischemia Trauma Demyelination Axonal degeneration Normal variant enhancement of Gasser ganglion and V2, V3
Adenoid cystic carcinoma Mucoepidermoid carcinoma Squamos cell carcinoma Adenocarcinoma
Ethmoidal Adenocarcinoma with perineural spread in pterigopalatine fossa
Role of imaging
Diagnosis Extent of disease – criteria of surgical resectability Treatment planning – surgical approach Follow-up – reccurence versus posttreatment changes
Thank you !