Date : 00.00.00
Name of the Patient : Abc Xyz G. Palmn / M / 49 yrs.
Referred by : Dr. Abc Xyzsbekar.
Examination : M.R.I. of the Brain.
CLINICAL PROFILE :
C/O decreased hearing bilaterally since April 0000.
M.R.I of the brain was performed using the following parameters :
5 mm thick T1 Weighted, proton and T2 Weighted axial images.
5 mm thick T1 Weighted and FLAIR coronal images.
5 mm thick T1 Weighted sagittal images.
There is seen an expansile lesion involving the clivus. This lesion is of intermediate signal on the T1 Weighted images and appears relatively hypointense on the T2 Weighted images. The margins of the clivus are not well-defined. The lesion is seen to extend anteriorly upto the posterior nasopharyngeal wall. Posteriorly the lesion is seen to indent the basilar artery and the pons with slight effacement of the prepontine cistern. There is no definite extension of the lesion into the cavernous sinus on either side. The sphenoid sinus is not well identified. Destruction of the dorsum sella is noted. The pituitary gland is however well identified separate from the lesion.
Inflammatory changes are noted in the left maxillary sinus, frontal sinuses, ethmoidal air cells and the middle ear.
There is an ill-defined, hyperintense signal on the proton, T2 Weighted and FLAIR images along the right posterior parietal cortex and in the left frontal cortex. This lesion appears relatively hypointense on the T1 Weighted images. Resultant slight volume loss is noted in this region. Small bright foci on the proton and T2 Weighted images are noted in the centrum semiovale bilaterally.
Both the lateral, third and the fourth ventricles are normal. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
1. An expansile mass lesion in the region of the clivus, with extensions as described, is not specific for a single etiology. A clival or a sphenoid sinus neoplasm or a small cell tumor (a nasopharyngeal carcinoma is less likely) may be considered as the differential diagnosis.
2. Altered signal in the right posterior parietal cortex, in the left frontal cortex and centrum semiovale bilaterally, most likely represent ischemic changes.