Esthesioneuroblastoma methods of intracranial extension: CT and MR imaging findings.
BACKGROUND
Esthesioneuroblastoma (ENB) is an aggressive neuroectodermal malignancy in the upper nasal cavity with local infiltration and lymphatic or hematogenous metastasis. The purpose of this paper is to document three types of direct intracranial extensions by ENB using computed tomography (CT) and magnetic resonance imaging (MRI).


METHODS
Eleven patients with pathologically confirmed ENB were admitted in our hospital between December 2002 and December 2008. Their magnetic resonance (MR; n = 10) and CT (n = 8) images were retrospectively reviewed, and particular attention was paid to tumor location and extension, enhancement pattern, cervical lymph node metastasis, and Kadish stage.


RESULTS
The majority of patients were male (8/11) with Kadish stage C tumor (10/11). Three types of direct intracranial extension by ENBs were put forward according to their MR and CT findings. The primary tumors were well-defined soft-tissue masses centered in the roof of the nasal cavity eroding into the paranasal sinuses (11/11), the contralateral nasal cavity (4/11), the cranial cavity (5/11), and the fossa orbitalis (3/11). The tumor parenchyma were hypointensity on T1-weighted images, heterogeneous hyperintensity on T2-weighted images, and isodensity or slight hyperdensity on CT images with scattered necroses (4/11) and marginal cysts(4/11). Their enhancements were significant and inhomogeneous. Cervical lymph nodes metastases were observed in four patients (4/11), but no pathologically proved distant metastasis was observed.


CONCLUSIONS
Three types of direct intracranial extensions by ENB can be found on CT and MRI: cranio-orbital-nasal-communicating ENB, cranio-nasal-communicating ENB, and orbital-nasal-communicating ENB.
Yu
Tian
T
Department of Medical Imaging Center, Nan Fang Hospital, Southern Medical University, No. 1838 Guangzhou Avenue North, Guangzhou, Guangdong, 510515, China.
Xu
Yi-Kai
YK
Li
Long
L
Jia
Fei-Ge
FG
Duan
Gang
G
Wu
Yuan-Kui
YK
Li
Hua-Yu
HY
Yang
Rui-Meng
RM
Feng
Jie
J
Ye
Xiang-Hua
XH
Qiu
Ying-Wei
YW
D000293:Adolescent; D001932:Brain Neoplasms / Q000175:diagnosis*; D002648:Child; D018304:Esthesioneuroblastoma, Olfactory / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009296:Nasal Cavity / Q000000981:diagnostic imaging* / Q000473:pathology*; D009669:Nose Neoplasms / Q000175:diagnosis*; D014057:Tomography, X-Ray Computed / Q000379:methods*; D055815:Young Adult