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Case Reports
. 2020 Jan 9;6(1):e03090.
doi: 10.1016/j.heliyon.2019.e03090. eCollection 2020 Jan.

Calvarial osteomyelitis in secondary syphilis: evaluation by MRI and CT, including cinematic rendering

Valentina Petroulia  1 , Bernard Surial  2 , Rajeev Kumar Verma  1 , Christoph Hauser  2 , Arsany Hakim  1
Affiliations
Case Reports

Calvarial osteomyelitis in secondary syphilis: evaluation by MRI and CT, including cinematic rendering

Valentina Petroulia et al. Heliyon. .

Abstract

This is a case of a 22-year-old, HIV-negative, male patient with asymptomatic syphilitic osteomyelitis of the skull in the context of secondary syphilis. The diagnosis was made based on serology as well as CT and MRI scans. CT volumetric data was post-processed with cinematic rendering, which is a novel algorithm that allows for a photorealistic visualization of the lesions. Imaging and follow-up scans after treatment confirmed the diagnosis without the need to perform invasive procedures such as a biopsy.

Keywords: CT; Cinematic rendering; Infectious; Infectious disease; MRI; Medical imaging; Medical microbiology; Nervous system; Neuroscience; Osteomyelitis; Postprocessing; Radiology; Sexually transmitted diseases; Skull; Syphilis.

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Figures

Figure 1
Figure 1
Axial DWI/ADC Map (A,B), T2-spin echo (C) and 3D gadolinium enhanced fat saturated T1 MRI in axial plane (MPRAGE) showing a diffusion restricted skull lesion and adjacent soft tissue in the left frontal bone left (arrow) with T2 – hyperintense Signal of the skull lesion and T2 – hyperintense soft tissue and with correlated enhancing soft tissue.
Figure 2
Figure 2
Axial (A) and sagittal (C) 3D gadolinium enhanced fat saturated T1 MRI (MPRAGE) showing an ill-defined skull lesion in the left frontal bone (thick arrow) with enhancing soft tissue process. A similar smaller lesion (thin arrow) is present in the right frontal bone. A significant decrease of both lesions was seen in the follow-up MRI (B and D) three months after the onset of therapy.
Figure 3
Figure 3
Axial images of head CT in bone window (A) and MIP reconstruction (C), which was performed a year prior to the current presentation, with no evidence of skull lesions. The present CT (B) shows an osteolytic lesion (arrow) in the left frontal bone. The MIP reconstruction (D) shows multiple osteolytic lesions in frontal and parietal bones bilaterally (lesions marked in circles).
Figure 4
Figure 4
Post-processing of the initial head CT using cinematic rendering depicting the multiple osteolytic lesions of the skull. The image provides a realistic impression of the lesions.
See this image and copyright information in PMC

References

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