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Arrested Pneumatization of the Skull Base: Imaging Characteristics

Kirk M. Welker1, David R. DeLone1, John I. Lane1 and Julie R. Gilbertson1

1 Department of Radiology, Division of Neuroradiology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.


Figure 1
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  		Fig. 1A —46-year-old woman referred for evaluation of possible chordoma. However, unenhanced CT showed findings of arrested pneumatization. Coronal CT image through sphenoid shows bilateral abnormal marrow trabecular pattern involving basisphenoid bone in location that often corresponds to lateral recesses of sphenoid sinus. Lesion has narrow sclerotic margins (arrows) and occasional internal curvilinear calcifications (arrowheads).

 

Figure 2
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  		Fig. 1B —46-year-old woman referred for evaluation of possible chordoma. However, unenhanced CT showed findings of arrested pneumatization. Same CT image as A displayed with soft-tissue windows shows multiple foci of fat density within lesion (arrows).

 

Figure 3
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  		Fig. 1C —46-year-old woman referred for evaluation of possible chordoma. However, unenhanced CT showed findings of arrested pneumatization. Axial CT image shows that lesion extends into pterygoid processes bilaterally (asterisks). Note that margins of lesion have merged with cortex of sphenoid bone at this level.

 

Figure 4
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  		Fig. 1D —46-year-old woman referred for evaluation of possible chordoma. However, unenhanced CT showed findings of arrested pneumatization. Axial CT image shows additional extension inferoposteriorly into clivus (arrow) with preservation of sphenoid bone cortex.

 

Figure 5
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  		Fig. 2 —Coronal CT image in 50-year-old man shows arrested pneumatization of left basisphenoid bone occurring in association with prominent sphenoid sinus lateral recess on right. Left vidian canal (black arrow) passes directly through region of arrested pneumatization; however, bone cortex of canal is preserved. Right vidian canal passes through sphenoid sinus (white arrow).

 

Figure 6
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  		Fig. 3A —MRI features of arrested pneumatization in 30-year-old woman imaged for follow-up of oligodendroglioma (not shown) and seizures. Axial T1 image (TR/TE, 550/14; number of excitations [NEX], 1) shows circumscribed region of increased T1 signal involving left basisphenoid (arrow) adjacent to sphenoid sinus (S). Findings suggest fat occurring in association with arrested pneumatization. Note that T1 signal of lesion exceeds T1 signal in adjacent clivus (asterisk).

 

Figure 7
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  		Fig. 3B —MRI features of arrested pneumatization in 30-year-old woman imaged for follow-up of oligodendroglioma (not shown) and seizures. Axial contrast-enhanced fast spin-echo T2 image (5,200/98; NEX, 2) of same lesion (arrow) shows heterogeneous T2 signal that is predominantly increased relative to normal clival marrow. Given fast spin-echo T2 technique and corresponding T1 hyperintensity, dominant regions of T2 hyperintensity are consistent with fatty content. S = sphenoid sinus.

 

Figure 8
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  		Fig. 4 —Arrested pneumatization of right occipital bone in 61-year-old man. Axial CT image shows large region of accessory pneumatization in left occipital bone (black arrow). There is arrested pneumatization of analogous portion of right occipital bone (white arrow). Lesion has osteosclerotic border and internal curvilinear calcifications.

 

Figure 9
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  		Fig. 5A —Arrested pneumatization distinguished from fibrous dysplasia. Axial CT image in 34-year-old man with arrested pneumatization shows arrested pneumatization of left basisphenoid. Note thin osteosclerotic margin (arrowheads) and internal curvilinear calcifications (arrow). Lesion is nonexpansile and does not narrow adjacent inferior orbital fissure (asterisk).

 

Figure 10
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  		Fig. 5B —Arrested pneumatization distinguished from fibrous dysplasia. Axial CT image of same patient in A at level of lateral pterygoid plates shows that although arrested pneumatization extends to involve inferior left pterygoid process (arrow), bone is not expanded.

 

Figure 11
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  		Fig. 5C —Arrested pneumatization distinguished from fibrous dysplasia. Axial CT image in 72-year-old woman with presumptive fibrous dysplasia of left basisphenoid. Note that diffuse sclerotic matrix pattern of fibrous dysplasia (arrow) differs significantly from pattern of arrested pneumatization. Lesion is expansile, with convex borders (arrowheads) that narrow pterygopalatine fossa.

 

Figure 12
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  		Fig. 5D —Arrested pneumatization distinguished from fibrous dysplasia. Axial CT image in same patient as C shows overt expansion of left lateral pterygoid plate (arrows) by fibrous dysplasia.

 

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