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Clival Tumors and Mimics: When It’s Not A Chordoma 2013

Category General Spine Ali Noor, MD
Amish Doshi, MD
David Well, MD
Keyur Patel, MD
Puneet Pawha, MD
Peter Som, MD
Purpose There are a variety of both common and uncommon lesions that can involve the clivus. A number of these entities have similar and often overlapping imaging appearances. The purpose of this exhibit is to review the imaging features of these lesions and provide a succinct differential diagnosis. Materials & Methods A retrospective review of our imaging cases of different clival lesions that had pathological correlation was performed. Between 2010 and the present time, 10 cases were identified. Results In this group of patients the clinical presentations were often noncontributory to diagnosis. Symptomatology included headache, localized pain or in the case of pituitary lesions, pituitary-axis dysfunction. Therefore, imaging has become an important tool in differentiating these entities. Benign and malignant tumors involving the clivus are often difficult to differentiate as many of these lesions have overlapping features on CT and MRI. Location, local bony changes, signal characteristics and enhancement patterns may allow the radiologist to provide a narrowed differential diagnosis. Sphenoid  mucocoele, meningioma, chondrosarcoma, ecchordosis physaliphora, a rare olfactory neuroblastoma, and invasive pituitary adenoma are some of the lesions that can have imaging findings similar to that of a chordoma, however, they are quite different in their treatment and prognosis. In this exhibit, the imaging appearance and underlying pathology of these entities will be reviewed. The imaging features that permit some distinction between these diagnoses will be emphasized. Conclusion Clinical presentations of patients with lesions in the clivus are often not helpful in identifying an underlying pathology. Imaging has become a very important tool. Because there are overlapping imaging features for many of these entities, arising at a pertinent and limited differential diagnosis is of utmost importance to the ordering clinician.  References Eren, E et al. (July 2003), Comprehensive Review of Intracranial Chordoma. Radiographics. 23: 995-1009. Soo, M. Y. (2001), Chordoma: Review of clinicoradiological features and factors affecting survival. Australasian Radiology, 45: 427–434.