Tumors and tumor-like conditions of the clivus. A comprehensive review.

Congress:

ECR 2012

Poster Number:

C-1581

Type:

Educational Exhibit

Keywords:

Neoplasia, Metastases, Dysplasias, Education, MR, CT, Neuroradiology spine, Musculoskeletal bone

Authors:

A. Paniagua Bravo¹, I. Alba de Caceres², L. Ibañez Sanz¹, J. A. Guzman de Villoria³, S. Ossaba¹, J. CRESPO¹; ¹MADRID/ES, ²SAN SEBASTIAN DE LOS REYES/ES, ³Madrid, Ma/ES

DOI:

10.1594/ecr2012/C-1581

DOI-Link:

https://dx.doi.org/10.1594/ecr2012/C-1581

Fig. 1: Normal clivus appearance. MDCT scan with MIP reformat in the axial view (A),...

Fig. 2: Chordoma MRI. Isointensity is seen on T1-weighted images (A) with moderate...

Fig. 3: Chordoma CT and MR study. CT (A) shows a soft-tissue mass with bone destruction...

Fig. 4: Non-enhanced CT scan performed in a patient with multiple mieloma. Bone focal...

Learning objectives

The main objective is to describe the normal appearance of the clivus and some disorders that typically affect this area, focused on the characteristics on MR and CT imaging that we should be familiar with in order to make an accurate diagnosis.

Background

Due to its strategic location in the skull base and its embryologic origin, some disorders typically affect the clivus. After a quick review of the normal anatomy of the skull base, we classified these lesions into: a) neoplastic processes arising from the clivus like chordoma, plasmacytoma, lymphoma, chondrosarcoma, meningioma and metastatic tumors. b) tumor-like conditions such as fibrous dysplasia, Paget disease, Langerhans hystiocytosis and radionecrosis. c) paraclival lesions which often involve the clivus: pituitary macroadenoma and nasopharyngeal neoplasms. To summarize, a comparison between the main...

Imaging findings OR Procedure details

ANATOMY (figure 1) The clivus is the part of the skull base situated between the foramen magnum and the dorsum sellae. It results from the fusion of the synchondrosis between the basioccipital and exoccipital bones, with growth and ossify from the 3 to the 25 year of age to form the basisphenoid and the basiocciput1. The anterior margin of the clivus abuts the sphenoidal sinus, whereas the posterior surface is the anterior limit of the prepontine and premedullary cisterns . The inferior margin represents the...

Conclusion

Clival disorders encompass a range of entities whose knowledge is crucial for diagnosis. MDCT and MRI allow a correct diagnosis of most of these conditions, a reliable distinction between benign and malignant processes and, when necessary, an excellent evaluation of the tumor extent.

Personal Information

References

1. Hofmann E, Prescher A. The Clivus: Anatomy, Normal Variants and Imaging Pathology. Clin Neuroradiol. 2011;28. 2. Ginsberg LE. Neoplastic diseases affecting the central skull base: CT and MR imaging. AJR Am J Roentgenol. 1992; 159:581-9. 3. Braun IF, Nadel L. The central skull base. In: Som PM, Bergeron RT. Head and neck imaging, 2nd ed. St. Louis: Mosby, 1991:875-924. 4. Sze G, Uichanco LS III, Brant-Zawadzki MN, et al. Chordomas: MR imaging. Radiology 1988;166: 187-191. 5. Oot RF, Melville GE, New PFJ, et al....