Magnetic Resonance (MR) and Computed Tomography (CT) Imaging of Pathological Entities of the Cavernous Sinus: A Pictorial Review

The cavernous sinus (CS) represents a highly complex venous structure located at the skull base, with intimate relationships to critical neurovascular structures, as well as the pituitary gland and adjacent sphenoid sinus. Because of these intricate anatomical associations, a wide spectrum of pathologies—ranging from infective, inflammatory, granulomatous, vascular and neoplastic causes —can arise within or extend into the cavernous sinus, often leading to significant morbidity. These lesions are not always biopsy-amenable, therefore cross-sectional imaging plays a crucial roley in characterizing the underlying etiology, determining disease extent, assessing complications, and guiding management. This pictorial review will focus on demonstrating a wide variety of pathological conditions involving the CS with the associated presenting symptoms. Characteristic imaging aspetcs, relevant clinical features, and an algorith for differential diagosis/management on CT/MRI will be presented. Fig. 1 Benign Masses. A-B) Nonenhancing fluid signal masses in the posterior to mid cavernous sinus, representing arachnoid cysts. C-D) Enhancing mass involving the cavernous sinus, extending to the posterior sella, clival and suprasellar region, representing a meningioma. E-F) Enhancing mass cystic component involving the right pre-pontine cistern extending to the left cavernous sinus, representing a schwannoma. Fig. 2 Malignant Masses. A-B) Enhancing mass involving the left cavernous sinus and the anterior temporal leptomeninges, representing metastatic breast cancer. C-D) Enhancing mass arising from the left inferior sella with associated cortical dehiscence, involving the cavernous sinus and left sphenoid sinus, representing chondrosarcoma. E-F) Mildly enhancing mass distending the left cavernous sinus, encasing the left internal carotid artery, representing lymphoma. Fig. 3 Inflammatory/Infectious Processes. A-B) Enhancing masses involving bilateral cavernous sinuses, representing neurosarcoidosis. C-D) Heterogeneous enhancing distension of the left cavernous sinus with associated restricted diffusion, representing thrombophlebitis with abscess collection. E-F) Enhancing mass involving the left cavernous sinus, Meckel cave, also extending to the superior orbital fissure, representing Tolosa-Hunt Syndrome. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany