J Korean Soc Radiol.  2016 Jan;74(1):43-54. 10.3348/jksr.2016.74.1.43.

Imaging Findings of Various Calvarial Bone Lesions with a Focus on Osteolytic Lesions

• Yim Y
• Moon WJ
• An HS
• Cho J
• Rho MH

• KMID: 2150462
• DOI: http://doi.org/10.3348/jksr.2016.74.1.43

Abstract

In this review, we present computed tomography (CT) and magnetic resonance imaging (MRI) findings of various calvarial lesions on the basis of their imaging patterns and list the differential diagnoses of the lesions. We retrospectively reviewed 256 cases of calvarial lesion (122 malignant neoplasms, 115 benign neoplasms, and 19 non-neoplastic lesions) seen in our institutions, and classified them into six categories based on the following imaging features: generalized skull thickening, focal skull thickening, generalized skull thinning, focal skull thinning, single lytic lesion, and multiple lytic lesions. Although bony lesions of the calvarium are easily identified on CT, bone marrow lesions are better visualized on MRI including diffusion-weighted imaging or fat-suppressed T2-weighted imaging. Careful interpretation of calvarial lesions based on pattern recognition can effectively narrow a range of possible diagnoses.

MeSH Terms

Bone Diseases
Bone Marrow
Bone Marrow Diseases
Diagnosis
Diagnosis, Differential
Magnetic Resonance Imaging
Retrospective Studies
Skull
Tomography, X-Ray Computed

Figure

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  Fig. 1 A 70-year-old male with multiple myeloma. On lateral skull radiograph (A) and axial CT (B), multiple punch-out osteolytic lesions in the skull (salt and pepper) are seen, a pathognomonic finding of multiple myeloma.

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  Fig. 2 A 70-year-old female with renal cell carcinoma. A. On contrast-enhanced CT, two huge osteolytic soft tissue masses with extreme enhancement in right parietooccipital and left frontotemporal bone are seen (arrows). B. On lateral skull radiograph, two huge osteolytic lesions (arrows) are seen. C. On MRI, huge soft tissue metastatic tumors show heterogeneous signal intensity on diffusion-weighted imaging (arrows).

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  Fig. 3 A 4-year-old girl with Langerhans cell histiocytosis. A. On lateral skull radiograph, a focal osteolytic lesion (arrow) is visible. B. Non-contrast CT shows a localized osteolytic lesion with beveled edges in the right frontal bone (arrow). C, D. On MRI, the osteolytic mass shows heterogeneous signal intensity on a T2-weighted image (arrow) (C) and marked enhancement with focal cystic change on the gadolinium-enhanced T1-weighted image (arrow) (D).

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  Fig. 4 A 45-year-old male with osseous hemangioma. A. On lateral skull radiograph, a small osteolytic lesion (arrow) is seen in the right parietal skull. B, C. A focal mass is detected with non-enhancing low signal intensity (arrow) on coronal gadolinium-enhanced T1-weighted MR image (B) and high signal intensity (arrow) on coronal T2-weighted MR image (C).

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  Fig. 5 A 13-year-old boy with epidermoid cyst of the skull. Lateral skull radiograph (A) and axial CT (B) show a large lucent area with well-defined sclerotic margin (arrow) in the right parietal bone. The lesion shows heterogeneous bright signal intensity on coronal T2-weighted image (arrow) (C), and shows thin wall enhancement on non-contrast (arrow) (left in D) and contrast-enhanced T1-weighted images (arrow) (right in E).

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  Fig. 6 A 58-year-old female with intracalvarial meningioma. A. A small well-defined radiolucent lesion (arrow) is seen on lateral skull radiograph. B. The pre-contrast CT scan shows a well-defined mildly expansile osteolytic meningioma (arrow) on the right parietal bone. C, D. This mass shows iso-signal intensity (C) on T2-weighted image (arrow) and contrast enhancement (arrow) (D) when gadolinium is applied.

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  Fig. 7 A 35-year-old male with fibrous dysplasia. A. On non-contrast CT, an expansile lesion (arrow) with internal ground-glass opacity emerging from the occipital bone is seen. B, C. On coronal T1-weighted image (B) and T2-weighted image (C), the lesion shows iso signal intensity (arrow) and mixed signal intensity (arrow), respectively. D. It shows heterogeneous but marked enhancement (arrow) when gadolinium is added.

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  Fig. 8 A 59-year-old male with skull lymphoma. A. On axial gadolinium-enhanced T1-weighted MR images, multiple homogeneous enhancing mass lesions are seen in both parietal bones (arrow in right parietal bone lesion). B, C. The lesions show hyperintensity on diffusion-weighted imaging (arrow) (B) and iso signal intensity on the T2-weighted image (arrow) (C).

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  Fig. 9 A 1-year-old girl with desmoplastic fibroma. A. A focal osteolytic lesion with sclerotic border (arrow) is seen near the right coronal suture on non-contrast CT. B, C. The lesion shows prominent enhancement on the gadolinium-enhanced T1-weighted image (arrow) (B), but shows low signal intensity relative to brain parenchyma on diffusion-weighted imaging (arrow) (C).

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  Fig. 10 A 45-year-old man with atretic cephalocele and persistent falcine sinus. Coronal plain radiograph (A) shows a well-defined bony defect (arrow) in the interparietal region. On a T2-weighted image (B), a U-shaped hypointense subscalp lesion (arrows) which extends to a congenital bony defect is detected. Anomalous persistent falcine sinus is noted as well (open arrow). On contrast-enhanced MR venograph, marked stenosis (arrow) of the persistent falcine sinus (open arrow) at the junction of the falcine and superior sagittal sinuses is noted (C). Reprinted from Cho J, Kim MY, Roh HG, Moon WJ. MR images of spontaneously involuted atretic cephalocele concomitant with persistent falcine sinus in an adult. J Korean Soc Magn Reson Med 2006;10:117-120; with permission.

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