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Methtrexate Neurotoxicity
Joseph Junewick, MD FACR
over 9 years ago
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Juvenile Ossifying Fibroma

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Neoplasia Benign
Created: over 7 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: CT MR
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Teenager with headache after minor trauma.

Case Images


CT – Posterior right epidural hemorrhage with geographic mixed density transdiploic lesion.

MR – Predominantly T1 and T2 hyper intense skull lesion with intermediate gradient susceptibility and restricted diffusion.


Juvenile ossifying fibroma is a slowly growing, benign tumor made of highly cellular fibrous connective tissue with varying amounts of mineralized foci. Juvenile ossifying fibroma typically involves the craniofacial skeleton (most commonly the paranasal sinuses) and children/young adults (mean age at presentation of 21 years and an age range of 3 months to 72 years). Radiographically, the lesion appears as a single, round or ovoid, well-demarcated, expansile lesion with marked variability of the matrix. On CT images, it is composed mostly of enhancing soft tissue with a variable amount of internal foci of punctate calcifications and cystic changes. MR images show isointensity relative to muscle on T1-weighted images and iso- to hypo intensity on T2-weighted images; occasionally susceptibility artifact is present secondary to hemorrhage. After administration of contrast, solid and septal components enhance. Differential considerations include fibrous dysplasia, aneurysmal bone cyst, osteoblastoma and osteosarcoma. Complete local excision is usually curative but surveillance imaging is recommended to evaluate for local recurrence.


Chang HJ, Donahue JE, Sciandja KT, et al. Juvenile Ossifying Fibroma of the Calvaria. RadioGraphics 2009; 29:1195–1199

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