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Figure 17. 65-year-old man with skull base Wegener's granulomatosis. (a) An axial T1 weighted image of the skull base shows significant sphenoid sinus disease, with direct extension into the petrous apices bilaterally (black arrows). This patient had multiple cranial nerve neuropathies, which is typical for this disease extent. Bilateral low signal granulomatous orbital disease is also shown (white arrows). (b) An axial T1 weighted image following intravenous gadolinium enhancement shows marked enhancement of inflammatory tissue in the petrous apices and sphenoid sinus (arrows), but to a lesser extent in the orbits, confirming granulomatous rather than active inflammatory tissue in this area.
