Clival masses
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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 above or from below the base of skull below.
When evaluating the clivus it is important to compare the marrow signal to that of the adjacent pons on noncontrastnon 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
- midline
- bright on T2
- thumb sign
- elevated pituitary out of pituitary fossa
- bony fragments
-
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
- invasive pituitary macroadenoma
- arises from pituitary fossa
- no normal pituitary identifiable
-
meningioma
- may be intraosseous
- dural tail
- hyperostosis may be present
- craniopharyngioma
Head and neck spaces growing up into clivus
- mucocoele of the sphenoid sinus
- nasopharyngeal carcinoma
- squamous cell carcinoma of the nasopharynx, sphenoid sinus or posterior ethmoidal air cells
- nasopharyngeal rhabdomyosarcoma
-<p>The differential of a mass involving or arising from the <a href="/articles/clivus">clivus</a> is a relatively narrow one and can be divided into whether the lesion arises from the <a href="/articles/base-of-skull">skull base</a> itself, from the intracranial compartment or from below the <a href="/articles/base-of-skull">base of skull</a>. </p><p>When evaluating the clivus it is important to compare the marrow signal to that of the adjacent pons on noncontrast, non fat saturated T1 sequences. Sagittal projection is most useful <sup>3</sup>. See: <a href="/articles/normal-bone-marrow-signal-of-the-clivus">normal bone marrow signal of the clivus</a>.</p><h4>Base of skull</h4><ul>- +<p>The differential of a mass involving or arising from the <a href="/articles/clivus">clivus</a> is a relatively narrow one and can be divided into whether the lesion arises from the <a href="/articles/base-of-the-skull">skull base</a> itself, the intracranial compartment above or the <a href="/articles/base-of-the-skull">base of skull</a> below.</p><p>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 <sup>3</sup>. See: <a href="/articles/normal-bone-marrow-signal-of-the-clivus">normal bone marrow signal of the clivus</a>.</p><h4>Base of skull</h4><ul>
-<li><a href="/articles/thumb-sign-of-chordoma">thumb sign</a></li>- +<li><a href="/articles/thumb-sign-chordoma-1">thumb sign</a></li>
-<a href="/articles/chondrosarcoma-of-the-base-of-skull">chondrosarcoma</a><ul>- +<a href="/articles/chondrosarcoma-of-the-skull-base">chondrosarcoma</a><ul>
-</ul><h4>Head and neck growing up into clivus</h4><ul>- +</ul><h4>Head and neck spaces growing up into clivus</h4><ul>
-<a href="/articles/mucocoele">mucocoele</a> of the <a href="/articles/sphenoid-sinus">sphenoid sinus</a>- +<a href="/articles/mucocele-1">mucocoele</a> of the <a href="/articles/sphenoid-sinus">sphenoid sinus</a>
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