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Clival masses

The differential of a mass involving or arising from the clivus is a relatively narrow one and can be divided into whether the lesion arises from the skull base itself, from the intracranial compartment or from below the base of skull.  

When evaluating the clivus it is important to compare the marrow signal to that of the adjacent pons on non contrast, non fat saturated T1 sequences. Sagittal projection is most useful 3 See normal bone marrow signal of the clivus.

Base of skull

  • metastasis
    • aggressive soft tissue mass
    • often patient has a known malignancy
  • chordoma
  • chondrosarcoma
    • paramedian, arising from the petro-occipital fissure 
    • also bright on T2 (chondroid matrix)
    • intralesional calcifications in >50%
    • elevated pituitary out of pituitary fossa
  • plasmacytoma
    • T2 signal low to intermediate
  • intraosseous lymphoma
  • neuroenteric cyst 2
    • can be located with in the base of skull or in the intracranial compartment
    • signal intensity varies depending on content

Intracranial compartment growing down into clivus

Head and neck growing up into clivus

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