Neuroradiology #11 – Long case

47-year-old male:
* Presented with epistaxis

Axial & coronal CT+C

Where is the lesion?

The bulk of the tumour is within the ethmoid sinuses extending inferiorly into the nasal cavity and superiorly into the intracranial cavity through the cribriform plates

What is the lesion like?

Enhancing soft-tissue tumor expanding the ethmoid sinuses and nasal cavity

T2, T1 and T1+C

What are the MRI signal characteristics?

Mixed signal intensity on T2, low signal on T1, and intense enhancement on post-contrast images

What is the differential diagnosis of paranasal sinus tumour?

* Olfactory neuroblastoma:  involves the ethmoid sinuses  and extends through the cribriform plate into the anterior cranial fossa. Usually, shows intense enhancement and may show calcifications. They are slow growing with sinus expansion

* Juvenile angiofibroma: benign locally aggressive vascular  tumor that affects adolescents. It is usually lobulated and expands the sphenopalatine foramen. Intense enhancement on post-contrast images

* Sinonasal carcinoma: heterogeneously enhancing mass that erodes the bone and may extend into the orbits or intracranially

* Lymphoma: low T2 signal with intense contrast enhancement and usually expands the bone

Diagnosis:Olfactory neuroblastoma

4 thoughts on “Neuroradiology #11 – Long case

  1. Illdefined soft tissue density is seen at the left nasal cavity, left ethmoidal air cells with intracranial extension. the lesion shows inhomogeneous enhancement at post contrast CT image. it displays mixed predominatly high T2 signal, low signal at T1 image and inhomogeneous enhancement at post contrast image. the lesion likely neoplastic in nature ?malignant , ?adenocarcinoma ?? meningioma.

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  2. where,what: lesion is involving left ethamoidal air cells , nasal meatus on left side and extending into extra dural space . extension across nasal septum seen. lesion appears solid enhancing and aggressive.
    MRI:Hypo on T1 ,hyper on T2 with enhancement on post gado.
    D/D: SCC of paranasal sinuses ,sinonasal carcinoma, olfactory neuroblastoma, lymphoma, polfactory neuroepithelioma.
    most favoured SCC

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