Skull Imaging-Radiographs and CT revisited

Although rare, skull vault lesions include a vast array of pathology encompassing infection, benign, and malignant bone tumors. Given the large range of potential diagnoses, it is crucial to identify imaging features to differentiate one from another, ensuring early diagnosis. Radiographs are still valuable in modern radiology but have largely been superseded by computed tomography (CT) due to its high spatial resolution. Both are especially important in developing countries where access to magnetic resonance imaging (MRI) may be limited.There are currently several publications outlining imaging appearances of skull vault lesions. However, the majority of literature is dated, with the last dedicated textbook published in 1980 (Principles of X-ray diagnosis of the skull). Despite overlapping features, a few lesions have "aunt minnie," type classical characteristics, which we will highlight. Most vault lesions also appear as a spectrum depending on location and the exact stage of the disease. A small subset within each disease entity also has atypical features not widely discussed in the current literature. In this pictorial review, we hope to focus on radiographic and CT imaging appearances to help differentiate between various skull vault lesions.