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AJNR - American Journal of Neuroradiology

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Osteomyelitis of the Skull in Early-Acquired Syphilis: Evaluation by MR Imaging and CT

I. Huang^a, J.L. Leach^a,d, C.J. Fichtenbaum^b and R.K. Narayan^c,d

^a Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, Ohio
^b Department of Infectious Diseases, University of Cincinnati College of Medicine, Cincinnati, Ohio
^c Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
^d The Neuroscience Institute, Cincinnati, Ohio

View larger version (75K): [in this window] [in a new window]   Fig 1. CT images of the vertex calvaria. A, Axial CT image (2.5-mm section thickness) demonstrates irregular bone destruction involving the calvaria. The outer cortex is predominantly involved. Irregular channel-like areas of bone destruction are best demonstrated in the vertex lesion (arrow). B, 3D volume-rendered image (using 2.5-mm reconstructed images) demonstrates the irregular worm-eaten nature of the destructive lesions, characteristic of syphilitic osteomyelitis. (arrows).

View larger version (107K): [in this window] [in a new window]   Fig 2. A, Axial fast spin-echo (FSE) T2-weighted image with fat saturation (TR, 3300 ms; TE, 86.4 ms; echo-train, 12). B, Coronal spin-echo T1-weighted image (TR, 400 ms; TE, 8.0 ms) after gadolinium administration (20 mL). Axial FSE T2-weighted image (A) demonstrates abnormal marrow edema in the frontal bone (arrow). There is subgaleal/periosteal inflammatory tissue adjacent to the right frontal destructive lesion, which exhibits increased signal intensity on T2-weighted image (A, white arrowhead). The bone destruction is irregular and predominantly involves the outer cortex (A, black arrowhead). The vertex lesion enhances intensely, involving nearly the entire thickness of the calvaria (B, black arrowhead). Mild dural enhancement is noted along the right convexity (B, arrow), consistent with inflammatory involvement. The adjacent subgaleal/periosteal inflammatory process enhances intensely (white arrowheads). No parenchymal signal-intensity abnormalities are identified.