Craniofacial Manifestations of Systemic Disorders: CT and MR Imaging Findings and Imaging Approach

Abstract

Many systemic diseases or conditions can affect the maxillofacial bones; however, they are often overlooked or incidentally found at routine brain or head and neck imaging performed for other reasons. Early identification of some conditions may significantly affect patient care and alter outcomes. Early recognition of nonneoplastic hematologic disorders, such as thalassemia and sickle cell disease, may help initiate earlier treatment and prevent serious complications. The management of neoplastic diseases such as lymphoma, leukemia, or Langerhans cell histiocytosis may be different if diagnosed early, and metastases to the maxillofacial bones may be the first manifestation of an otherwise occult neoplasm. Endocrinologic and metabolic disorders also may manifest with maxillofacial conditions. Earlier recognition of osteoporosis may alter treatment and prevent complications such as insufficiency fractures, and identification of acromegaly may lead to surgical treatment if there is an underlying growth hormone-producing adenoma. Bone dysplasias sometimes are associated with skull base foraminal narrowing and subsequent involvement of the cranial nerves. Inflammatory processes such as rheumatoid arthritis and sarcoidosis may affect the maxillofacial bones, skull base, and temporomandibular joints. Radiologists should be familiar with the maxillofacial computed tomographic and magnetic resonance imaging findings of common systemic disorders because these may be the first manifestations of an otherwise unrevealed systemic process with potential for serious complications. Online supplemental material is available for this article. RSNA, 2018.

Spectrum of lytic lesions of the skull: a pictorial essay

“…13 ). To better evaluate the bone marrow infiltration, MRI is usually performed, also providing high sensitivity in the detection, even in the absence of lysis [ 38 , 39 ].

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Uremic leontiasis ossea: distinctive imaging features allow differentiation from other clinical causes of leontiasis ossea

“…Even pathologically, ULO can be interpreted as other causes of craniofacial overgrowth such as fibrous dysplasia [10] . Generally, the findings of osteomalacia on imaging are non-specific and include reduced bone density, loss of cortical definition, and coarsening of the trabecular pattern in addition to Looser zones or pseudofractures; a type of insufficiency fractures [20 , 21] . On the other hand, hyperparathyroidism presents with bone resorption as most common radiological manifestations [22] .…”

“…On the other hand, hyperparathyroidism presents with bone resorption as most common radiological manifestations [22] . The bone resorption in the skull best described as “salt and pepper” appearance caused by multiple lucencies in background of sclerotic ground-glass appearance associated with indistinct inner and outer tables [21 , 22] . Such ground-glass pattern can be mistaken with fibrous dysplasia, however, in ULO appears to be diffuse with loss of corticomedullary differentiation [10] .…”

“…Subperiosteal resorption can also be observed in the lamina dura, which is the bone surrounding the tooth sockets [20] . Osteitis fibrosa cystica is another manifestation of hyperparathyroidism as a result of activation of the osteoclasts and replacement of the bone marrow by vascular and fibrous tissues [ 21 , 22 ]. Brown tumor is an extreme form of osteitis fibrosa cystica which presents as solitary or multifocal lytic lesions [ 20 , 21 ].…”

“…Osteitis fibrosa cystica is another manifestation of hyperparathyroidism as a result of activation of the osteoclasts and replacement of the bone marrow by vascular and fibrous tissues [ 21 , 22 ]. Brown tumor is an extreme form of osteitis fibrosa cystica which presents as solitary or multifocal lytic lesions [ 20 , 21 ]. Osteosclerosis can be also seen in particular during the healing phase with characteristic increased bone density of the vertebral end-plates (rugger-jersey spine) [22] .…”