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Skull Base-related Lesions at Routine Head CT from the Emergency Department: Pearls, Pitfalls, and Lessons Learned
Hernan R Bello1, Joseph A Graves1, Saurabh Rohatgi1
1From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, Emory University Midtown Hospital, 550 Peachtree Rd, Atlanta, GA 30308 (H.R.B., J.A.G., M.V., R.B.P.); Department of Radiology, University of Massachusetts Medical School, Worcester, Mass (S.R.); Department of Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, Tex (J.M.); and Department of Radiology, University of Arkansas for Medical Sciences, Little Rock, Ark (R.V.H., S.G.).
Abstract:
Routine non-contrast material-enhanced head CT is one of the most frequently ordered studies in the emergency department. Skull base-related pathologic entities, often depicted on the first or last images of a routine head CT study, can be easily overlooked in the emergency setting if not incorporated in the interpreting radiologist's search pattern, as the findings can be incompletely imaged. Delayed diagnosis, misdiagnosis, or lack of recognition of skull base pathologic entities can negatively impact patient care. This article reviews and illustrates the essential skull base anatomy and common blind spots that are important to radiologists who interpret nonenhanced head CT images in the acute setting. The imaging characteristics of important "do not miss" lesions are emphasized and categorized by their cause and location within the skull base, and the potential differential diagnoses are discussed. An interpretation checklist to improve diagnostic accuracy is provided. ©RSNA, 2019.
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