In this case the appearances are due to a meningioma of the right side of the falx. Meningiomas are a recognised cause of uptake on bone isotope imaging due to a variety of reasons. These may result in increased uptake due to primary calcification of the tumour itself or as in this case due to reactive bone changes or osteoblastic activity in the adjacent calvarium or falx cerebri. Recall also that bone isotope uptake can also occur in acute necrotic processes such as acute cerebral infarction.
The lateral projection of the skull demonstrates extensive additional sclerosis in the frontal region. On this single lateral projection the appearances are suggestive of hyperostosis frontalis interna, a common cause of sclerosis, particularly in female patients. However, the select images of the skull from the bone isotope imaging demonstrates that the findings are strongly unilateral and extensive. These appearances are non-specific. Several different considerations could be entertained including the possibility of metastatic disease although a single site of disease in the calvarium of this size would be unusual. Indeed this patient had no other foci of disease elsewhere. The differential for this appearance is limited to metastatic disease, Paget’s disease (for which there is no radiographic evidence) and meningioma.
In this case the appearances are due to a meningioma of the right side of the falx. Meningiomas are a recognised cause of uptake on bone isotope imaging due to a variety of reasons. These may result in increased uptake due to primary calcification of the tumour itself or as in this case due to reactive bone changes or osteoblastic activity in the adjacent calvarium or falx cerebri. Recall also that bone isotope uptake can also occur in acute necrotic processes such as acute cerebral infarction.
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