Pictorial Essay Radiology

Pictorial Essay Radiology-75
Skull X-ray is usually the first diagnostic tool on which lesions are identified, but its use is decreasing due to the availability of more accurate imaging techniques, such as computed tomography (CT) and magnetic resonance imaging (MRI).CT is useful for the evaluation of lesion density (sclerotic or osteolytic), extension assessment (focal or diffuse) and recognition of possible pathognomonic patterns, such as the trabecular pattern of haemangioma.Protruding into the brain’s dural sinuses, they allow for CSF resorption.

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Furthermore, it is the best modality for the depiction of possible periosteal reaction.

A better tissue characterisation and evaluation of bone marrow involvement is obtainable on MRI.

An intradiploic location is less common compared to other intracranial locations [5].

Intradiploic epidermoid cysts (IECs) are the most common, occurring at any age from the first to seventh decades of life, with no gender prevalence.

They receive blood from superficial cortical and meningeal veins, and CSF from AG.

Some VL can enlarge, extending from the skull inner table into the diploic space, providing a lytic image of the skull on CT scan (Fig. They behave as pure vascular entities, with contrast enhancement on both CT and MRI. Axial CT image with bone (a) window showing a lytic lesion within the left parasagittal diploic space (arrowhead), confirmed on T2-weighted sequence (b).It is also more accurate than CT in the assessment of intra- and extracranial extension.In this review article, we will discuss pseudolesions (e.g.In such cases, they are referred to as “giant AGs”, proceeding in differential diagnosis with other dural entities, such as extradural masses and venous thrombosis [2].Due to their content, on CT scans, AGs appear as well-defined, round-shaped lesions with CSF density, protruding into the calvarium, causing a filling defect (Fig. Similarly, on MR images, AGs are characterised by low signal on T1-weighted images and hyperintensity on T2-weighted images, hypointense on fluid-attenuated inversion recovery (FLAIR) sequence and without contrast enhancement.They are preferentially found in the frontal, parietal and occipital regions, often affecting multiple bones [6].IECs, due to their slow growth, usually show a small diameter at diagnosis [7].An early and correct characterisation of the nature of the lesion is, therefore, crucial, in order to achieve a fast and appropriate treatment option.In this review, we present the radiological appearance of the most frequent lytic lesions of the skull, describing findings from different imaging modalities (plain X-rays, CT and MRI), with particular attention to diagnostic clues and differential diagnoses.• Osteolytic skull lesions may be challenging to diagnose.• Association of different imaging techniques may aid image interpretation.• Clinical information and extensive knowledge of possible differential diagnoses is essential.• Some osteolytic tumours, although benign, may present as locally aggressive lesions.• Malignant lesions require accurate staging, followed by variable treatment approaches.However, “giant AGs” may show atypical MRI findings, with higher-than-expected T1- and FLAIR-weighted signal [2]. Axial computed tomography (CT) images with brain (a) and bone (b) windows showing two well-defined, round-shaped lesions with cerebrospinal fluid (CSF) density, protruding into the calvarium along the right transverse sinus Venous lacunae (VL) consist of enlarged venous spaces within the parasagittal dura, adjacent to the superior sagittal sinus [3].Usually, three VL are localised in each hemisphere, at the frontal, parietal (the most common location) and occipital lobes.


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