Imaging of skull vault tumors in adults

Abstract

The skull vault, formed by the flat bones of the skull, has a limited spectrum of disease that lies between the fields of neuro-and musculoskeletal radiology. Its unique abnormalities, as well as other ubiquitous ones, present particular features in this location. Moreover, some benign entities in this region may mimic malignancy if analyzed using classical bone-tumor criteria, and proper patient management requires being familiar with these presentations. This article is structured as a practical review offering a systematic diagnostic approach to focal calvarial lesions, broadly organized into four categories: (1) pseudolesions: arachnoid granulations, meningo-/encephaloceles, vascular canals, frontal hyperostosis, parietal thinning, parietal foramina, and sinus pericrani; (2) lytic: fibrous dysplasia, epidermal inclusion and dermoid cysts, eosinophilic granuloma, hemangioma, aneurysmal bone cyst, giant cell tumor, metastasis, and myeloma; (3) sclerotic: osteomas, osteosarcoma, and metastasis; (4) transdiploic: meningioma, hemangiopericytoma, lymphoma, and metastasis, along with other less common entities. Tips on the potential usefulness of functional imaging techniques such as MR dynamic susceptibility (T2*) perfusion, MR spectroscopy, diffusion-weighted imaging, and PET imaging are provided.

A unique case of multiple calvarial hemangiomas with one large symplastic hemangioma

“…Erosions of both internal or external plates can occur and may be associated with internal or external tumor expansion. Sometimes, bony trabeculae can grow beyond the cortical bone, and simulate an aggressive pseudo- “hair-on-end” periosteal reaction [ 32 ]. From MRI, the signal intensity depends on the fat content, which is hyperintense on T1 and T2.…”

Primary extraosseous dural chondrosarcoma: a case report

“…The absence of myo-inositol went against SFT-HPC while the absence of a known primary malignancy, the unifocality of the tumor, and the absence of an aggressive underlying bone pattern did not support metastasis. With all these considerations in mind, the preoperative radiological diagnosis was of meningioma, considering SFT-HPC and dural metastasis as less probable differentials [ 3 – 7 ].…”

“…In this scenario, advanced imaging sequences play an important role in the presurgical diagnosis. Extremely high CBV and low PSR values on DSC-PWI and the presence of alanine on spectroscopy can be diagnostic clues for meningioma [ 3 – 5 ].…”

Skull vault hemangioma mimicking neoplastic lesion on [68Ga]Ga-PSMA-11 PET/CT in a patient with glioblastoma: A case report

“…The pathogenesis is not clearly elucidated [9] . Patients are rarely symptomatic (pain, mass effect) [10] . On the CT, SVH usually presents a well-delineated and limited intradiploid osteolytic lesion with sharp edges with a "honeycomb" appearance.…”