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Date : 00.00.00

Name of the Patient : Abc Xyzttam Prajalmn / M / 51 yrs.
Referred by : Dr. Abc Xyzah.
Examination : M.R.I. of the Brain.


C/O headaches since 1 month with diplopia and ptosis since 20 days.
H/O recently detected DM.


M.R.I of the brain was performed using the following parameters :

5 mm thick T1 Weighted, proton and T2 Weighted axial images.
3 mm thick T1 Weighted and STIR coronal images.
5 mm thick T1 Weighted sagittal images.


There is an intermediate signal intensity mass lesion, on the T1 Weighted images, which turns hyperintense on the T2 Weighted images having its epicentre in the sphenoid sinus. There is replacement of the normal marrow of clivus by hypointense areas on the T1 Weighted images. These are seen to turn heterogeneously hyperintense on the proton, T2 Weighted and STIR images. There appears to be erosion of the clivus posteriorly with extension of the pathologic process into the prepontine cistern. There is extension into the cavernous sinus bilaterally with encasement of the cavernous segments of the internal carotid arteries bilaterally which show normal flow void signal on all the pulse sequences. Superiorly there is encasement of the anterior pituitary gland. Anteriorly there is extension in the spheno-ethmoidal recess with involvement of the posterior ethmoidal air cells bilaterally. Laterally there is indentation of the medial aspect of the temporal lobes, with probable involvement of the meninges. The pterygoid muscles bilaterally show hyperintense signal on the T2 Weighted and STIR images with soft tissue extension into the infratemporal fossa.
- 2 - Scan - 00009

There is no focal area of altered signal intensity within the brain parenchyma.

Both the lateral, third and the fourth ventricles are normal. There is no shift of the midline structures.

Incidental note is made of inflammatory changes in the maxillary sinuses and in the middle group of ethmoidal air cells.


The MRI features suggest a mass lesion having its epicentre in the sphenoid sinus with extensions as described. The possibilities to be considered are:

1. Squamous cell carcinoma of the sphenoid sinus.

2. Metastasis.

3. Infective process seems less likely.
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