Imaging of Mucormycosis Skull Base Osteomyelitis
Ling-Ling Chana,
Sanjay Singha,
Dan Jonesa,
Eduardo M. Diaz Jr.a and
Lawrence E. Ginsberg
,a
a From the Departments of Diagnostic Radiology (L-L.C., S.S., L.E.G.), Pathology (D.J.) and Head and Neck Surgery (E.M.D.), the University of Texas M.D. Anderson Cancer Center, Houston, Texas.
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FIG 1. Axial CT image through the skull base. A 5-mm-section using a standard soft-tissue algorithm and bone windowing shows mucosal thickening in the sphenoid sinuses, focal bony destruction of the right lateral sphenoid sinus wall (white arrowheads), and subtle lytic foci in the clivus (black arrowheads).
FIG 2. Photomicrograph of the sphenoid sinus wall reveals broad hollow-appearing hyphae with 90° branching (arrowheads at 90° to each other) characteristic of mucormycosis. A large necrotic bone fragment is seen centrally (methanamine silver stain, original magnification x400)
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FIG 3. MR images through the skull base.
A, Axial T1-weighted (600/12/2 [TR/TE/excitations]) MR image, obtained from an outside institution and performed 10 weeks prior to CN VI palsy onset, reveals foci of signal hypointensity in the clivus and bilateral petrous apexes (arrowheads).
B, Axial T1-weighted (600/9/2) MR image, obtained at our institution 10 weeks after A, shows progressive heterogeneity of the marrow fat in the central skull base.
C, Contrast enhanced fat-suppressed coronal T1-weighted (600/9/2) MR image shows bilateral, thick, smooth enhancement of the dura of the medial wall and floor of the middle cranial fossae (arrowheads) and abnormal marrow enhancement in the clivus (asterisk).
FIG 4. A 3-mm-thick CT image obtained using a high-resolution bone algorithm postoperatively more clearly shows the extensive erosive changes in the central skull base (brackets)
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AJNR - American Journal of Neuroradiology