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Neuroradiologie Scan 2012; 02(04): 275-300
DOI: 10.1055/s-0032-1310085
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© Georg Thieme Verlag KG Stuttgart · New York

Läsionen der Felsenbeinspitze: Klassifizierung und Befunde in der CT- und MRT-Bildgebung[1]

Lesions of the petrous apex: classification and findings at CT and MR imaging
Ahmed Abdel Razek
,
Benjamin Y. Huang
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Publication History

Publication Date:
01 October 2012 (online)

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Zusammenfassung

Die Felsenbeinspitze (Apex partis petrosae) stellt eine komplexe Region an der zentralen Schädelbasis dar, die von einer Reihe wichtiger Gefäß- und Nervenstrukturen umgeben ist und in der sich viele verschiedene Krankheitsprozesse abspielen können. Läsionen, die in der Felsenbeinspitze auftreten oder sich dorthin ausbreiten, verursachen unterschiedliche und gelegentlich schwere klinische Folgeerscheinungen, meist bedingt durch eine raumfordernde Wirkung oder durch die unmittelbare Invasion der Hirnnerven, des Hirnstamms oder der A. carotis interna. Da die Felsenbeinspitze einer direkten Untersuchung nicht zugänglich ist, spielen die mittels Computertomografie und Magnetresonanztomografie erstellten Querschnittsaufnahmen eine wichtige Rolle für die Diagnose und Charakterisierung dort auftretender Läsionen. Läsionen der Felsenbeinspitze lassen sich anhand ihres Ursprungs in die folgenden Kategorien einordnen: entwicklungsbedingte Läsionen, entzündliche Läsionen, benigne Tumoren, maligne Tumoren, Gefäßläsionen und Knochendysplasien. Die häufigsten in der Felsenbeinspitze auftretenden Läsionen sind Cholesteringranulome, die sich aufgrund ihrer hohen Signalintensität sowohl in T1 – als auch in T2-gewichteten Aufnahmen zuverlässig mittels MRT diagnostizieren lassen. Auch die Kenntnis anatomischer Varianten und häufiger Pseudoläsionen in der Felsenbeinspitze ist wichtig, um deren Verwechslung mit pathologischen Zuständen zu vermeiden.

Abstract

The petrous apex is a complex region of the central skull base that is surrounded by a number of important vascular and neural structures and can be home to a wide range of disease processes. Lesions arising in or spreading to the petrous apex cause varied and occasionally severe clinical sequelae, which typically result from mass effect or direct invasion of the cranial nerves, brainstem, or internal carotid artery. Because the petrous apex is not amenable to direct examination, cross-sectional imaging with computed tomography and magnetic resonance (MR) imaging plays an important role in diagnosis and characterization of lesions occurring there. Petrous apex lesions can be classified on the basis of their origin into the following categories: developmental lesions, inflammatory lesions, benign tumors, malignant tumors, vascular lesions, and osseous dysplasias. The most common lesions arising in the petrous apex are cholesterol granulomas, which can be reliably diagnosed with MR imaging due to their high signal intensity on both T1-weighted images and T2-weighted images. In addition, one should also be familiar with anatomic variants or pseudolesions in the petrous apex that can be mistaken for pathologic conditions.

1 © 2012 The Radiological Society of North America. All rights reserved. Originally puplished in English in RadioGraphics 2012; 32: 151 – 173. Online published in 10.1148/rg.321105758. Translated and reprinted with permission of RSNA. RSNA is not responsible for any inaccuracy or error arising from the translation from English to German.


 

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