Male, 16 years old, with Ewing's sarcoma and new calvarial epidural metastases. Brain:The marrow space of the calvarium and skull base is diffusely heterogeneous and infiltrated.The dura along the left cerebral hemisphere is almost uniformly thickened and enhancing with an undulating pattern of nodular thickening which measures up to 8 mm in thickness at the parietal vertex. Abnormal enhancing tissue is also evident within the extracranial scalp, particularly at the left parietal vertex where a tumor nodule measures up to 8 mm thickness.Epidural and extracranial tumor is also evident centered on the left sphenoid wing. These lesions extend into the left middle cranial fossa and also into the left orbit exerting mass effect upon the lateral rectus muscle.Smooth dural thickening is evident to a lesser degree along the right cerebral hemisphere. Slightly nodular tumor is seen along the right greater sphenoid wing, and along the floor of the right middle cranial fossa with extension along and into the right cavernous sinus and Meckel's cave. Tumor is also suspected within the right sphenoid sinus with inferior extension to potentially involve the right nasopharyngeal mucosal space.As noted on the prior CT, epidural thickening does appear to involve the space between the occipital bone and the inferior aspect of the superior sagittal sinus. This results in some degree of sinus narrowing.Although areas of epidural thickening do exert minimal mass effect on the adjacent brain parenchyma, no evidence of brain invasion or parenchymal edema is seen. No pathologic parenchymal enhancement is detected. No intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology.Spine:All visualized osseous elements of the spine demonstrate diffuse marrow replacement with patchy superimposed pathologic enhancement. Vertebral body heights are, however, preserved, and spinal alignment is anatomic.Within the limitations of mild motion degradation, no evidence of any significant epidural tumor extension is seen. At most, there appears to be some mild extraosseous tumor extension along the right lateral mass of C2.The spinal canal is preserved with no evidence of significant stenosis at any level. The spinal cord itself shows normal morphology and signal characteristics. The conus terminates normally at the T12-L1 level.
Diffuse infiltrative tumor involvement of the calvarium and skull base is seen. This results in fairly widespread involvement of the epidural space. The left sided dura is most significantly involved with scattered undulating areas of nodular epidural tumor. Prominent epidural and extracranial tumor is seen at the left parietal vertex.Tumor is evident centered on the left greater sphenoid wing with extension into both the left middle cranial fossa and the left orbit. There is mass effect upon the left lateral rectus muscle.Epidural tumor is seen along the right greater sphenoid wing extending along the floor of the middle cranial fossa, up along and into the right cavernous sinus and Meckel's cave. Tumor is also highly suspected within the right sphenoid sinus with inferior extension potentially into the nasopharyngeal mucosal space. Also of note, epidural tumor is evident along the inferior aspect of the superior sagittal sinus resulting in some degree of venous sinus narrowing.Marrow space tumor is evident diffusely throughout the spine. However, no evidence of any significant epidural tumor extension is seen. The spinal canal is preserved and the spinal cord is free of significant abnormalities.