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Osteoma - cranial vault

Case contributed by Ammar Haouimi
Diagnosis almost certain

Presentation

Chronic headaches

Patient Data

Age: 40 years
Gender: Female
mri

The MRI sequences demonstrate a rounded bony mass arising from the inner table of left frontal region, and protruding towards the frontal lobe which is compressed, and displaced with no adjacent white matter edema seen. It shows a very low signal as the cortical bone on all sequences.

Case Discussion

MRI features of an ivory osteoma of the cranial vault, also known as eburnated osteoma: dense bone lacking Haversian system

The differential diagnosis includes:

  • intraosseous meningioma: seen mainly in women in fifth-sixth decades, usually located near the sutures 1. On CT seen as an osteosclerotic lesion with an irregular spiculated borders 1. On MRI it shows a low signal on T1, variable signal on T2 with no enhancement following IV contrast 1. MRI is indicated to rule out a meningioma en plaque 1.
  • fibrous dysplasia: seen predominantly in children and young adults 1. It is typically expanded, with focal area of cystic enlargement of the outer table 1. CT is the best imaging modality for diagnosis, it shows the characteristic ground-glass appearance 1.


Additional contributor: T. Arar MD CHU Batna, Algeria

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