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Congress: ECR24
Poster Number: C-22510
Type: EPOS Radiologist (educational)
DOI: 10.26044/ecr2024/C-22510
Authorblock: M. Luna Gonzalez, C. Nogues Maldonado, S. Carmona Bartolomé, H. Lajusticia Andrés, A. M. Moll Servera, M. A. Orozco Botero, M. D. C. Gassent Balaguer, M. J. Picado Valles, A. Mas Bonet; Palma/ES
Disclosures:
Manuel Luna Gonzalez: Nothing to disclose
Cristina Nogues Maldonado: Nothing to disclose
Sara Carmona Bartolomé: Nothing to disclose
Héctor Lajusticia Andrés: Nothing to disclose
Apollonia María Moll Servera: Nothing to disclose
Mónica Alejandra Orozco Botero: Nothing to disclose
María Del Carmen Gassent Balaguer: Nothing to disclose
María José Picado Valles: Nothing to disclose
Antonio Mas Bonet: Nothing to disclose
Keywords: Anatomy, Head and neck, Oncology, CT, MR, Diagnostic procedure, Education, Neoplasia
Learning objectives To describe the anatomy of petrous apex, normal MRI and CT appereance and surrounding structures.To categorize petrous apex abnormalities on the basis of their specific cause.To get across the diagnosis approach in Petrous Apex Lesions (PAL).To illustrate radiological findings in PAL and the role of both MRI and CT. To Identify/rule out complications.
Read more Background The petrous apex represents the pyramidal shaped medial portion of the temporal bone located between the inner ear structures laterally, petrosphenoidal fissure and internal carotid artery (ICA) anteriorly, petro-occipital fissure medially and the posterior cranial fossa behind. The superior surface is formed by the middle cranial fossa, Meckel cave, and ICA. Along the inferior surface are the jugular bulb and inferior petrosal sinus.The petrous apex is subdivided by the internal auditory canal (IAC) into an anterior (larger, typically contains bone...
Read more Findings and procedure details Classification of PAL:Developmental Lesions: Cholesterol granulomas: they are among the most common PAL; the suggested cause is that aggressive pneumatization of the petrous apex leads to exposure of bone marrow, whose hemorrhages lead to foreign-body reaction, subsequent cyst formation (filled with viscous brown fluid, granulation tissue, and cholesterol crystals) and bone remodeling and expansion. They are usually hyperintense on both T1- and T2-weighted images and will remain hyperintense after fat suppression. After contrast administration, there may be subtle peripheral enhancement secondary...
Read more Conclusion PAL include a wide spectrum of entities. Some of them, without a proper treatment, can be fatal. Radiologists need to be familiar with those disorders in order to establish differential diagnosis, avoid diagnosis delay or inappropriate invasive measures.
Read more References 1. Schmalfuss IM. Petrous apex. Neuroimaging Clin N Am. 2009;19(3):367-391. doi:10.1016/j.nic.2009.06.0092. Chaljub G, Vrabec J, Hollingsworth C, Borowski AM, Guinto FC Jr. Magnetic resonance imaging of petrous tip lesions. Am J Otolaryngol. 1999;20(5):304-313. doi:10.1016/s0196-0709(99)90032-73. Razek AA, Huang BY. Lesions of the petrous apex: classification and findings at CT and MR imaging. Radiographics. 2012;32(1):151-173. doi:10.1148/rg.3211057584. Chapman PR, Shah R, Curé JK, Bag AK. Petrous apex lesions: pictorial review. AJR Am J Roentgenol. 2011;196(3 Suppl):WS26-S43. doi:10.2214/AJR.10.72295. Pisaneschi MJ, Langer B. Congenital cholesteatoma...
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