Imaging Spectrum of Cavernous Sinus Lesions with Histopathologic Correlation

Abstract

Cavernous sinuses are paired interconnected venous plexuses situated in the floor of the middle cranial fossa on either side of the sella turcica and sphenoid sinus. They are lined by dura mater and consist of multiple venous channels within. The cavernous sinuses are intimately related to the internal carotid artery and its associated sympathetic plexus, the oculomotor nerve, the trochlear nerve, the abducens nerve, and the ophthalmic nerve. Cavernous sinuses are connected to the orbit, the pterygopalatine fossa, the infratemporal fossa, the nasopharynx, and the posterior cranial fossa by various foramina, fissures, and canals in the skull base. A multitude of structures in close relation to the cavernous sinus give rise to a myriad of possible pathologic conditions that can be broadly classified into (a) neoplastic, (b) vascular, (c) infective or inflammatory, or (d) miscellaneous lesions. These pathologic conditions can have overlapping clinical manifestations. Hence, imaging plays a crucial role in identifying the disease, assessing its extent, providing a pertinent differential diagnosis to guide further management, and suggesting a site or route for biopsy. MRI is the modality of choice to depict the cavernous sinuses, with CT and digital subtraction angiography playing supplementary roles in certain situations. In this article, the cavernous sinus lesions encountered in our institution during a 10-year period are reviewed. The purpose of the article is to (a) describe the anatomy of the cavernous sinus; (b) demonstrate the multimodality imaging spectrum of a wide variety of pathologic conditions involving the cavernous sinus, correlating with the histopathologic findings; (c) highlight important imaging clues for differential diagnosis; and (d) help the reader overcome potential pitfalls in interpretation.

Primary marginal zone B-cell lymphoma of the cavernous sinus: a case report and review of the literature

“…It describes an idiopathic inflammatory process characterized by painful ophthalmoplegia secondary to inflammation surrounding the cavernous sinus. The usual presentation is that of an enhancing soft tissue lesion involving both the orbital apex and cavernous sinus, features different from those observed in our case [38]. Hemangiomas are rare vascular lesions involving the cavernous sinus which, similar to those occurring elsewhere, exhibit marked hyperintensity on T2WI and progressive contrast filling (centripetal enhancement) on dynamic contrast-enhanced T1WI [39].…”

Clinical Significance of MRI Contrast Enhancement of the Oculomotor Nerve in Ischemic Isolated Oculomotor Nerve Palsy

“…MRI of the cavernous sinus using thin-section, fat-suppressed, T1-weighted sequences and contrast-enhanced sequences could clearly reveal the oculomotor nerve. 9 Most (71.1%) of the patients who were diagnosed as iIONP had enhancement of the third nerve in MRI of the cavernous sinus. We also read the MRI images of 48 patients with abductor nerve palsy and 18 with trochlear nerve palsy who were hospitalized during the same period, and only 1 of them had an enhanced oculomotor nerve at the same time.…”

“…All of the MRI images of the brain and cavernous sinus of these patients were read again by experts of radiology and neurology to reconfirm the results. The main MRI sequences for the cavernous sinus 9 were thin-section, fat-suppressed, T1-weighted sequences in the axial and coronal planes after intravenously injecting gadolinium-based contrast material. The section thickness was 3 mm.…”

Evaluation of image quality of pituitary dynamic contrast‐enhanced MRI using time‐resolved angiography with interleaved stochastic trajectories (TWIST) and iterative reconstruction TWIST (IT‐TWIST)

“…Laterality of the enhancement pattern in the cavernous sinus may reflect the differences of venous drainage in the cavernous sinus. Laterality of the enhancement pattern may be associated with carotid cavernous sinus, infectious, and inflammatory cavernous lesions; therefore, DCE‐MRI based on the actual temporal resolution may provide clinical impact in the evaluation of cavernous sinus diseases. Our results are consistent with a previous study of thoracic blood vessels .…”