Anterior Skull Base Tumors. Группа авторов
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Michelle Williams, MD
Department of Pathology, The University of Texas MD Anderson Cancer Center
1515 Holcombe Blvd, Unit 85
Houston, TX 77030 (USA)
E-Mail [email protected]
Nicolai P, Bradley PJ (eds): Anterior Skull Base Tumors. Adv Otorhinolaryngol. Basel, Karger, 2020, vol 84, pp 28–45 (DOI: 10.1159/000457923)
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The Role of Morphologic and Functional Imaging in Pretreatment Assessment
Roberto Maroldi Andrea Borghesi Marco Ravanelli Salvatore Golemi Davide Farina
Department of Radiology, University of Brescia, Brescia, Italy
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Abstract
Anterior skull base (ASB) tumors can be classified into three groups according to their site of origin: (1) sinonasal neoplasms involving or extending through the anterior cranial base; (2) neoplasms which arise from the bony framework of the base itself; (3) neoplasms originating from adjacent intracranial structures. With few exceptions, most of these tumors have a non-specific appearance on CT and MRI, which limits the role of imaging in terms of characterization. However, treatment planning (transnasal endoscopic surgery in particular) mostly depends upon the tumor map, exploiting the potential of modern cross-sectional imaging. As a result, the radiologist who has to evaluate a neoplasm involving the ASB needs to be fully aware of all the technical solutions available and the specific strengths/weaknesses of the different imaging techniques. Knowledge of radiological anatomy (and its variants) is also essential, which includes the ability to translate the CT appearance of structures into the equivalent MR signal (and vice versa). These main prerequisites have to be combined with up-to-date knowledge of treatment options and surgical procedures in order to be able to create a reporting checklist covering all the aspects that are essential for clinical decision making.
© 2020 S. Karger AG, Basel
The diagnostic work-up of neoplasms involving or arising from the anterior skull base (ASB) aims to achieve key data for treatment planning. Among these, four factors play a crucial role: the histological type, presence/absence of clinical signs of advanced disease, patient characteristics (age, comorbidities), and assessment of the local, regional, and distant extent by imaging [1–3].
With the exception of a few distinct benign histologies, such as osteoma, juvenile angiofibroma, inverted papilloma, and meningioma, the majority of sinonasal and skull base tumors have non-specific imaging features. Therefore, though imaging can help to narrow the differentials, the diagnosis of a suspicious lesion requires biopsy. In addition, besides discriminating benign and malignant neoplasms, histopathological diagnosis has a second key role: the histologic type may determine surgical versus non-surgical management [1].
While clinical findings of advanced local disease, such as neurological or ophthalmological signs, may suggest that a conservative surgical approach is unlikely to be indicated, it is only by exploiting the potential of high-resolution imaging that the detailed local extent and the resectability of a tumor can be accurately determined [4].
Fig. 1. Intestinal-type adenocarcinoma (T), CT (a), and TSE T2 (b) in the coronal plane. When a thin lamella is surrounded on both sides by a signal different from air, MRI shows the lamella as a thin hypointense line.