MR and CT Findings of Temporal BoneLangerhans Cell HistiocytosisJae Ig - PDF document

䨠䭯牥慮⁒慤楯氠卯挠㈰〱㬀㐵㨀㔀ㄳⴀ㔱㠀 MR and CT Findings of Temporal BoneLangerhans Cell HistiocytosisJae Ig Bae, M.D., Hee Jung Lee, M.D., Heung Sik Kim, M.D. To describe the MRI and CT findings of temporal bone Langerhans cell histi-ocytosis. The MRI (n=8) and CT (n=7) findings of nine lesions of tem-poral bone Langerhans cell histiocytosis in six children were retrospectively reviewed.Eight lesions were pathologically confirmed and one was clinically diagnosed. Thefindings were analyzed for bilaterality, location, lesion extent, signal intensity, the at-tenuation of soft tissue lesions seen at MRI or precontrast CT, enhancement pattern atMRI or CT, and the pattern of bony destruction at CT.Bilateral involvement was present in three of six patients (50%). Lesions weremost frequently located in the mastoid (n=8, 89%), followed by the petrous ridge(n=6, 67%), and the squamous portion (n=3, 33%). Seven (78%) lesions extended tothe ipsilateral cavernous sinus (n=3), sphenoid bone (n=3), orbit (n=2), or epiduralspace (n=2). The signals of the soft tissue lesions were isointense in five cases (63%)on T1-weighted images and hyperintense in six (75%) on T2-weighted images. Five le-sions (71%) were isodense on precontrast CT scans. The enhancement patterns wereinhomogeneous in six cases (75%) at MRI, and homogeneous in five (71%) at CT. Alllesions demonstrated bony destruction without periosteal reaction and five (71%)showed ill-defined destruction, with crossing sutures.Familiarity w

ith findings of predominant mastoid involvement, isoin-tense or isodense soft tissue lesions seen on T1-weighted images or at precontrast CT,with relatively homogeneous enhancement at CT, and irregular bony destruction withcrossing sutures may be helpful in narrowing the diagnosis of temporal boneLangerhans cell histiocytosis. Neoplasms, in infants and childrenTemporal bone, CT Tel. 82-53-250-7766, 7198 Fax. 82-53-250-7766 of disorders in which the idiopathic proliferation of histi-bone involvement of LCH is uncommon, with a report-ed frequency of between 18% and 61% (2). Clinical mis-important in the differentiation of disease from inflam-study was to determine the MR and CT findings of tem-poral bone LCH, and thus narrow the differential diag-We retrospectively investigated the MR and CT find-were pathologically confirmed by excision (n=5) or nee-dle aspiration biopsy (n=3). and the other lesion was di- C presented with a left postauricularlarge isodense soft tissue mass involv-and iso-to hyperintense on T2-weight-) demonstrates homogeneous en- A (Siemens, Erlangen, Germany) and the following imag-ing sequences: axial T1- and T2-weighted; contrast-en-hanced axial and coronal T1-weighted. The imaging pa-msec) for T2-weighted and 600/15 for pre- and postcon-(Omniscan, 0.2 mmol/kg; Nycomed, Norway) was ad-(seven lesions) using a Somatom Plus-S (Siemens,5.0 mm, with contrast-enhancement after the intra-on T1- and T2-weighted MR images, attenuation at pre-contrast CT and defined as hypodense, isodense

, or hy-Soft tissue lesions were iso- (n=5, 63%) (Fig. 1) or hy-weighted images and either hyper- (n=6, 75%) or isoin-T1-weighted images, and at pathologic examination, he-morrhagic foci were found to be present there. At pre-Postcontrast CT demonstrated homogeneous enhance-CT revealed bony destruction in all lesions with no pe-riosteal reaction. In five lesions (71%), ill-defined de-2), and in two there was well-defined punched-out de-䨠䭯牥慮⁒慤楯氠卯挠㈰〱㬀㐵㨀㔀ㄳⴀ㔱㠀 MR and CT Findings of the Temporal Bone LCH CasesLesionsLocationExtentT1WIT2WIGd-enhan.Pre-CTPost-CTBone destruction11Right; mastoid, petrousCavernous sinusIso.Iso.Inhomoⴭⴀ22Left; mastoid, petrous,Cavernous sinusHypo.Hyper.InhomoⴭⴀsquamousOrbit3*3Left; mastoid, squamousHypo.Hyper.Inhomo.HypodenseInhomo.Well-defined4Righ; mastoidSphenoidHypo.Hyper.Inhomo.IsodenseHomo.Well-defined4*5Left; mastoid, petrousEpiduralIso.Hyper.Homo.IsodenseHomo.Ill-defined6Right; mastoid. Iso. Hyper. Inhomo. Isodense Homo. Ill-defined57Right; mastoid, squamous EpiduralⴭⴀIsodenseHomo.Ill-defined6*8Left; mastoid, petrous Sphenoid Iso. Hyper. Inhomo. Hypodense Inhomo. Ill-defined9Right; petrous Carvenous sinus Iso. Iso. Homo. Isodense Homo. Ill-defined Absent; *, Bilateral lesions; , Temporal bone CT; T1WI, T1-weighted image; T2WI, T2-weighted image; Gd-enhan., Gd-enhancement; the skull, the calvarium is most frequently involved, fol-and can be suggested only as part of a differential diag-the presence of LCH (2).in our se

ries, and were thus more common than the pre-Findings of bilateral involvement, extension to the adja-9). These findings mimic ag-limited number of cases (10). Although the signal inten-sity was not specific in our study, soft tissue lesionsin the signal intensity seen on such images may be at-LCH is known to be marked by the proliferation of atyp-ical Langerhans cells. During the early phase of LCH, le-included in the differential diagnosis of hypercellular tu-rhabdomyosarcomas or chloromas, especially in the pe- A ) shows a relatively isodense soft tissue mass (H.U., 61.4) involving the petrous ridge, mastoid, and the squa-(H.U., 80.3). Temporal bone CT scan ( at CT (71%) but inhomogeneous at MRI (75%). This dis-crepancy between CT and MRI may be due to the supe-rior soft tissue resolution and higher contrast of the lat-with poorly delineated borders and can mimic a malig-s sarcoma or acute osteomyelitis, and-less fre-The lesion becomes progressively more sharply delin-benign appearance. CT clearly demonstrates osseous in-volvement. In most cases in our series, ill-defined per-calvarial or orbital LCH, where the lesions were de-scribed as having punched-out defect, with sharp mar-studies used conventional CT rather than high-resolu-the latter is an excellent means of determining the na-ture of an osseous lesion. In summary, findings of bilateral involvement, exten-tissue lesions are not specific for LCH. However, famil-iarity with findings of predominant mastoid involve-precontrast CT scan are help

ful in narrowing the diag-1.Mirra JM. In: Mirra JM, Picci P, Gold RH, eds. 2.Cunningham MJ, Curtin HD, Jaffe R, Stool SE. Otologic manifes-3.Hadjigeorgi C, Parpounas C, Zarmakoupis P, Lafoyianni S.Eosinophilic granuloma of the temporal bone: Radiological ap-4.Cunningham MJ, Curtin HD, Butkiewicz BL. Histiocytosis X of5.Hermans L, Foer BD, Smet MH, Leysen J, Feenstra L, Fossion E,6.Stull MA, Kransdorf MJ, Devaney KO. Langerhans cell7.Erly WK, Carmody RF, Dryden RM. Orbital histiocytosis X. 8.Stromberg JS, Wang AM, Huang TE, Vicini FA, Nowak PA.Langerhans Cell Histiocytosis involving the sphenoid sinus and su-9.Yi G, Yoon HK, Han BK, Kim KA, Choo IW. CT findings of orbital10.Monroc M, Pointe DL, Haddad S, Josset P, Montagne JP. Soft tis-11.Rosenfield NS, Abrahams JA, Jomp D. Brain MR in patients with12.McGahan JP, Osborn RA, Dublin AB, French BN. CT of䨠䭯牥慮⁒慤楯氠卯挠㈰〱㬀㐵㨀㔀ㄳⴀ㔱㠀 듫쟑맦믧벱샇쟐좸쇶㈰〱㬀㐵㨀㔀ㄳⴀ㔱㠀 쏸뗎냱䱡湧敲桡湳벼웷솶쇷놸쇵샇䵒₹휀䍔₼튰�냨룭샇듫떿믪샇럡뿸쇸드맦믧벱냺쟐놳뷇냨룭샇듫떿믪샇럡뿸볒뻆냺쟐놳뷇맨샧샍ꆤ샌죱솤ꆤ뇨죯뷄쏸뗎냱삻쒧맼쟑䱡湧敲桡湳벼웷솶쇷놸쇵샇䵒₹휀䍔₼튰�묀뻋뻆몸냭샚쟏뾴듙⸠㚸윀좯뻆뾡벭맟믽쟑㦿뤀몴몯샇쏸뗎냱䱡湧敲桡湳벼웷솶쇷놸쇵샇䵒
渽㠩₹휀䍔
渽㜩₼튰�묀죄쟢샻삸럎뫐벮쟏뾴듙⸠㢿맀윀몴몯삺솶쇷쟐샻볒냟삸럎좮쇸뗇뻺냭ã

†¿ë¦´ìˆ€ìƒ“믳샻삸럎쇸드뗇뻺듙⸠뾵믳볒냟삺몴몯샇뻧쏸벺Ⱐ삧쒡Ⱐ쒧맼맼삧Ⱐ뾬뫎솶쇷몴몯샇䵒뾡벭샇뷅좣낭떵뿍솶뾵쇵낭샼䍔뾡벭샇삽뾵Ⱐ솶뾵쇵낭뻧믳Ⱐ䍔₼툀냟뾡벭냱웄놫샇뻧믳Ⱐ뗮삻뫐벮쟏뾴듙⸠뻧쏸벺몴몯삺㎸㔰┩샌뻺듙⸠몴몯샇삧쒡듂삯뻧떹뇢낡㢿뤨㠹┩럎낡샥뢹뻒냭쏟쎼뫎㚿뤨㘷┩Ⱐ샎뫎쏸뗎냱㎿뤨㌳┩샇본샌뻺듙⸠㞿뤨㔶┩샇몴몯샌떿쏸샇쟘룩떿⡮㴳⤬⃁ꋇﲰ渽㌩Ⱐ뻈뿍⡮㴲⤬₹휀냦뢷뿜⠀뾬볓샻샎쒧맼삻몸뾴듙⸠뾬뫎솶쇷몴몯삺吱낭솶뾵믳뾡벭듂㖿뤨㘳┩뾡벭떿뗮뷅좣낭떵뢦Ⱐ吲낭솶뾵믳뾡벭듂㚿뤀⠷㔥⦰ꄀ냭뷅좣낭떵뢦몸뾴듙⸠솶뾵쇵낭샼䍔뾡벭듂㖿뤨㜱┩낡떿뗮삽뾵삻뎪언뎻뻺듙⸠솶뾵쇵낭삺䵒뾡벭듂㘀뾹⠷㔥⦿ꆼ관뫱뇕샏쟑뻧믳삻Ⱐ䍔뾡벭듂㖿뤨㜱┩뾡벭뇕샏쟑뻧믳삻몸뾴듙⸠냱웄놫듂䍔₼튰�샼럊⠱〰┩뾡벭몸뾴삸뎪냱뢷망샀삺냼싻뗇쇶뻊뻒냭Ⱐ㖿뤨㜱┩뾡벭뫀쟕삻냇돊낡듂뫒뇔쒢쟑뻧믳삻몸뾴듙⸀몴몯샌쇖럎삯뻧떹뇢⠸㤥⦿ꄀ삧쒡쟏냭Ⱐ뾬뫎솶쇷몴몯샌吱낭솶뾵믳뾡벭떿뗮뷅좣낭떵⠶㌥⦸ꘀ몸샌냭좤삺솶뾵쇵낣샼䍔뾡벭떿뗮삽뾵⠷ㄥ⧀첸관뫱놳샻뇕샏쟑솶뾵쇵낭⠵ㄥ⧀묀몸샌룧Ⱐ뫀쟕삻냇돊낡듂뫒뇔쒢쟑냱웄놫⠷ㄥ⤠볒냟샌냼싻뗇룩쏸뗎뾱䱡湧敲桡湳벼웷솶쇷놸쇵삻뷃믧쟏듂냍삸럎믧럡뗈듙⸀