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Altered marrow signal intensity is noted in the clivus and bilateral occipital condyles. These appear hyperintense on T1 and T2 weighted images. Subtle diffusion restriction is noted in the involved areas. There is post contrast enhancement noted in the involved regions with formation of a peripherally enhancing collection in the clivus. Enhancement is noted extending to the atlanto-occipital joint.
Few peripherally enhancing lesions are noted in the pons, which are hyperintense on T2W images. Mild surrounding edema with restricted diffusion is noted. MR spectroscopy from these lesions shows lipid-lactate peak at 0.9 and 1.3ppm. Features are highly suggestive of tuberculomas.