What is the evaluation of a smooth bony prominence on the skull?

From the Guidelines

A smooth osseous prominence on the skull should be evaluated through a combination of physical examination and imaging studies, with a CT scan being the preferred initial imaging modality due to its excellent bone detail and ability to differentiate between normal anatomical variants and pathological conditions 1. When evaluating a smooth osseous prominence on the skull, it is essential to start with a thorough clinical examination to document the size, location, tenderness, and mobility of the prominence.

Key Considerations

• The clinical examination should be followed by radiographic imaging to visualize the bony structure.
• A CT scan is preferred for more detailed assessment as it provides excellent bone detail and can help distinguish bony remodeling that is more typical of slow-growing or benign masses from lytic destruction seen with more aggressive malignancies 1.
• MRI may be indicated if soft tissue involvement is suspected, but CT is generally the first-line imaging modality for evaluating osseous changes.

Common Benign Findings

• Osteomas, which are slow-growing benign tumors
• Exostoses, which are benign outgrowths of bone
• Normal anatomical variants like parietal bossing or prominent inion

Management

• Most smooth skull prominences are benign, but evaluation is crucial to rule out more concerning conditions such as metastatic lesions or primary bone tumors.
• If the prominence is growing rapidly, painful, or associated with neurological symptoms, urgent evaluation is warranted.
• Management depends on the diagnosis, but often involves observation for benign, asymptomatic lesions, with surgical intervention reserved for symptomatic cases or those causing cosmetic concerns.

Imaging Modalities

• CT and MRI are complementary imaging modalities in the evaluation of sinonasal masses, localizing and characterizing lesions and determining their extent for treatment planning 1.
• CT maxillofacial enables surgical planning given its detailed depiction of sinonasal anatomy and can be used with surgical image-guidance systems when acquired with the appropriate protocol 1.

From the Research

Evaluation of Smooth Osseous Prominence on Skull

• The evaluation of smooth osseous prominence on the skull can be approached through various imaging modalities, including conventional radiography and MR imaging 2.
• Conventional radiography is crucial for assessing the tumor matrix and aggressiveness, while MR imaging is best for local staging 2.
• However, there are also normal osseous variants that can present as cystic or lucent areas on radiography and CT imaging, which may lead to false positive diagnosis of an osteolytic or cystic lesion 3.
• In the context of the skull base, the optimum imaging modality depends on the specific diagnostic question and area of interest, with both CT and MR having complementary roles 4.
• When evaluating smooth osseous prominence on the skull, it is essential to consider the range of pathologies that can occur in this region, including bone tumors that can arise de novo in soft tissues 5.
• The clinical, imaging, and histopathologic findings of these tumors can vary, and knowledge of these entities is crucial for making an accurate diagnosis 5.
• In some cases, osseous deformities can cause impingement and lead to clinical symptoms, and surgical removal of the deformity can result in significant improvement in symptoms 6.