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Poorly differentiated carcinoma from an unknown primary presenting with occipital condyle syndrome (MRI)

(A) Axial noncontrast T1-weighted MRI at the level of the hypoglossal foramina. Fat has the highest signal on noncontrast T1-weighted MRI, making it easy to see where neoplasm (arrow) replaces bone marrow fat. If CE T1-weighted MRI alone was inspected, the enhancement of this neoplasm would hide the lesion. (B) Sagittal noncontrast T1-weighted MRI at the level of the right occipital condyle. The low-signal neoplasm (red arrow) in the occipital condylar marrow is dramatically contrasted with the normal high signal (star) of the C1 fatty bone marrow. The ease of multiplanar acquisition with MRI has simplified anatomic understanding of such lesions. (Contributed by Dr. Zubair Shaikh.)