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Mucocele Involving the Anterior Clinoid Process: MR and CT Findings

C. C. Tchoyoson Lima, William P. DillonGo,a and Michael W. McDermotta

a From the Department of Diagnostic Imaging, Tan Tock Seng Hospital, Singapore (C.C.T.L.); and the Departments of Radiology (W.P.D.) and Neurological Surgery (M.W.M.), University of California at San Francisco.



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  		FIG 1. Case 1: 32-year-old woman with retroorbital headache and a long history of sinus disease.

A, Schematic representation of a sagittal section through the sphenoidal sinus (S) shows the relationship between Onodi cell (arrows), optic nerve (O), and pituitary gland (P). (Reprinted with permission from [7].)

B, T1-weighted (516/14/2 [TR/TE/excitations]) conventional spin-echo MR image shows an area of increased signal intensity (arrow) anterior and superior to the sphenoidal sinus (S), corresponding to the Onodi cell seen in A. Note that this is part of the posterior ethmoidal air cells (arrowhead).

C, Axial T1-weighted image (600/14/2) shows the mucus-filled Onodi cell extending into the left anterior clinoid process (arrow) and inferior to the optic nerve (arrowheads). Note that on axial images the optic nerve appears to course through the mucocele.

D, Coronal T1-weighted (550/14/2) (top) and T2-weighted (3700/105/2) (bottom) fast spin-echo MR images show that the mass (arrow) underlying the optic nerve (arrowhead) is of high signal intensity on the T1-weighted sequence and of intermediate intensity on the T2-weighted sequence.



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  		FIG 2. Case 2: 61-year-old man with sudden-onset diplopia and forehead numbness. Fourth cranial nerve palsy as well as V1 sensory loss was found on physical examination.

A, Axial T1-weighted image (600/14/2) shows a lesion of intermediate signal intensity extending laterally (arrows) as well as medially (arrowheads) around the left optic nerve. Note that, as in fig 1C, the optic nerve appears to course through the lesion, a clue to the sinus origin of the mass.

B, Contrast-enhanced T1-weighted (500/20/2) image with fat saturation reveals mild peripheral enhancement (arrows, arrowheads).

C, Axial T2-weighted (4000/105/2) fast spin-echo MR image shows the mass is isointense (arrow) to slightly hyperintense (arrowhead) relative to brain parenchyma. Mild inflammatory sinus disease is present in the ethmoidal air cells bilaterally.

D, Coronal contrast-enhanced T1-weighted (583/14/2) conventional spin-echo sequence with fat saturation shows the enhancing mass (arrow) involving the left anterior clinoid process (arrowheads) extending into the orbital apex.

E, Contiguous 1-mm high-resolution coronal CT scans show a soft-tissue attenuation lesion of the left anterior clinoid process (arrow) extending into the orbital apex. The cortex of the clinoid process is focally expanded and destroyed. A small polypoid soft-tissue mass (arrowhead) is also noted along the lateral surface of the left sphenoidal air cells.





Copyright © 2009 by the American Society of Neuroradiology. Print ISSN: 0195-6108 Online ISSN: 1936-959X