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CT, MRI and gallium SPECT in the diagnosis and treatment of petrous apicitis presenting as multiple cranial neuropathies

Department of ¹ Radiology and ² Otorhinolaryngology, Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea

View larger version (83K): [in a new window]   Figure 1. (a) Axial, (b, c) coronal CT images (bone window) reveal opacification of air cells in right mastoid, middle ear cavity and petrous apex. Bony erosion was demonstrated along the cortex surrounding the petrosal pyramid (arrowheads) and occipital condyle (straight arrows) with widened petroclival fissure (asterisk). Note collapsed right mandibular condyle with destruction (curved arrow).

View larger version (146K): [in a new window]   Figure 2. (a, b) T1 weighted images, (c) T2 weighted image, (d) enhanced T1 weighted image. Serial MR images show T1 low and T2 high signal intensity lesions involving the right petrous (arrowheads), occipital clivus (small straight arrows), mandibular condyle (curved arrow) and masticator space (large straight arrows) with strong enhancement to opacified mastoid air cells.

View larger version (102K): [in a new window]   Figure 3. (a) Gallium-67 scan at admission, (b) follow-up scan: initial scan demonstrates intense uptake in right petrous ridge and mastoid, indicating acute inflammation. Decreased uptake is noted in follow-up scan after 3 months of antibiotic treatment.