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Neuroradiology Case of the Week

Case 378

January 2009

Hisao Nakamura, MD and Per-Lennart Westesson MD, PhD, DDS

Clinical Presentation: Patient is a 31-year-old woman who noted a visible bump on her forehead two years ago. This examination was performed in order to differentiate intraosseous lesion.

Imaging Findings: Skull hemangioma.

Diagnosis: Skull hemangioma

Discussion: Hemangiomas of the calvaria account for 0.2% of all bone neoplasms. They are more common in women by a 3:1 ratio (our case is woman). Two types of tumor exist: the more common sessile type, which extends throughout the diploe of the skull, and the rare globular type, which tends to be expansible. This case is the globular type and can be found in any location in the skull, but they are often seen in the frontal and parietal regions. Fifteen percent of skull hemangiomas are multiple. The usual clinical presentation is a painless, palpable scalp mass.
     The characteristic imaging pattern on bone image CT is radiating spicules. MR characteristic imaging pattern is that T1-weighted images show hyperintensity within the diploic space. T2- weighted images reveal heterogeneous hyperintensity within the lesion, with hypointense borders. A stippled appearance is seen in the tumor matrix. The mass enhances intensely or heterogeneously after administration of contrast material.
     Angiographic evaluation is not done routinely. When the surgical option is considered, it is done to reduce intraoperative blood loss.

References:

1. Bastug D, Ortiz O, Schochet SS. Hemangiomas in the calvaria: imaging findings. AJR Am J Roentgenol. 1995 Mar;164(3):683-7. [PubMed]