Other “Don’t Touch” Skull Lesions: Arachnoid Granulations, Calvarial Depressions, Hemangiomas, and Intraosseous Lipomas

  • Alexander M. McKinney
Chapter
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Abstract

This subsection describes a few miscellaneous normal variants of the skull that can mimic lytic lesions. These include the often encountered pacchionian granulations, calvarial depressions, and the quite uncommon intraosseous lipomas. Pacchionian (arachnoid) granulations on CT could appear nearly identical to calvarial depressions from vascular channels; indeed, this distinction can be arbitrary and only based on the observation that calvarial depressions are filled with a clearly contrast-enhancing vascular channel, while arachnoid granulations are most commonly (but not always) filled with the T2-bright signal intensity of cerebrospinal fluid (CSF) on MRI, which suppresses/darken on FLAIR, uncommonly, these exhibit internal enhancement because of vasculature contained within. Intraosseous lipomas can be differentiated by their characteristic appearance and density on CT, although MRI can also help confirm that they are normal variants in questionable situations. Finally, calvarial hemangiomas can overlap with intraosseous lipomas if a hemangioma is small and T1-bright; however, larger hemangiomas have increasing enhancement, can be expansile, and can simulate lytic lesions such as metastases.

Keywords

Arachnoid granulations Pacchionian granulations Calvarial depressions Pacchionian depressions Calvarial protrusions Intraosseous lipomas Calvarial hemangiomas 
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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Alexander M. McKinney
    • 1
  1. 1.Neuroradiology Division Department of RadiologyUniversity of MinnesotaMinneapolisUSA

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