Langerhans Cell Histiocytosis in the Skull: Comparison of MR Image and Other Images

Lim, Soo Jin; Lim, Myung Kwan; Park, Sun Won; Kim, Jung Eun; Kim, Ji Hye; Kim, Deok Hwan; Lee, Seok Lyong; Suh, Chang Hae

Abstract

PURPOSE
To evaluate the characteristic MR imaging findings of Langerhans cell histiocytosis (LCH) in the skull and to compare them with those of plain radiography and computed tomography.
MATERIALS AND METHODS
A total of 10 lesions in 9 patients (Age range; 5-42 years, Mean age; 18, all women) with Langerhans cell histiocytosis in the skull were included in our study. Nine lesions in nine patients were histologically confirmed by surgery or fine needle aspiration biopsy. All patients performed with MRI, and plain radiography and CT scan were done in 7 patients (8 lesions). Two experienced neuroradiologists reviewed the radiological examinations independently with attention to location, size, shape and nature of the lesions in the skull and compared the extent and extension of the lesions to adjacent structures.
RESULTS
The lesions were distributed in all of the skulls without predilection site. On MRI, the masses were shown as well-enhancing soft tissue masses (10/10) mainly in diploic spaces (8/10) with extension to scalp (9/10) and dura mater (7/10). Dural enhancement (7/10) and thickening (4/10) were seen. The largest diameter of the soft tissue masses ranged 1.1 cm to 6.8 cm, shaped as round (5/10) or oval (5/10). On CT scans, the lesions were presented as soft tissue masses involving diploic space (6/8) and scalp extension (7/8) were also well visualized. Although bony erosion or destruction was more clearly seen on CT rather than those of MRI, enhancement of soft tissue masses and dura were not well visualized on CT. In contrast, all of the lesions in LCH were seen as punched out (4/8), beveled-edge appearance (4/8) osteolytic masses in plain radiography, but scalp and dural extension could not be seen.
CONCLUSION
Characteristic MR findings in patients with LCH are soft tissue mass in diploic space with extension to dura and scalp, and MRI would be better imaging modality than plain radiography or CT .