Date : 00.00.00
Name of the Patient : Abc XyzChandolmn / F / 60 yrs.
Referred by : Dr. Abc Xyzhalani.
Examination : M.R.I. of the Brain & Sella/Perisellar
CLINICAL PROFILE :
Known C/O Type II diabetes Mellitus with hypertension.
C/O swelling over BLE since 4-5 months. ? Cushings syndrome.
To r/o pituitary lesion.
M.R.I of the brain and sella with perisellar region was performed using the following parameters :
5 mm thick T1 Weighted, proton and T2 Weighted axial images.
3 & 4 mm thick T1 Weighted coronal images and 3 mm thick T2 Weighted coronal images.
After administration of contrast 3 mm thick T1 Weighted coronal images (with and without fat saturation), 3 mm thick T1 Weighted sagittal images and 5 mm thick T1 Weighted axial images were obtained.
There is seen an approximately 3.5 x 2.0 x 2.0 cms sized well-defined, lobulated, intermediate signal intensity, extra-axial, mass lesion on the T1 Weighted images in the prepontine cistern to the left of the midline, extending into the Meckles cave and the left parasellar region. This lesion appears significantly hyperintense on the proton and T2 Weighted images. There is minimal indentation on the left antero-lateral margin of the pons. The left fifth cranial nerve is not well-visualized separately from the mass lesion. The lesion is
seen to indent the left cavernous sinus and the cavernous segment of the left internal carotid artery. This vessel however shows normal flow void signal. No significant extension of the mass lesion into the left intratemporal region is noted, though there is a suspicion of a widening of the left foramen ovale.
There are ill-defined, hyperintense areas on the proton and T2 Weighted images in the subcortical white matter in the frontal regions bilaterally. These lesions appear isointense to normal white matter on the T1 Weighted images.
There is mild fullness of both the lateral ventricles. The third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.
After administration of contrast, there is near uniform enhancement of the lesion in the prepontine cistern to the left of the midline extending into the left parasellar region. Central nonenhancing area is however noted within this lesion (? necrosis).
There is no enhancement of the white matter lesions in the frontal regions bilaterally.
There is no abnormal meningeal enhancement noted.
The pituitary gland is normal in its size, contour and location and reveals normal signal intensity. The posterior pituitary gland reveals normal hyperintense signal on the T1 Weighted images. The pituitary stalk is in the midline. The hypothalamus is unremarkable.
The suprasellar cistern and the right cavernous sinuses are unremarkable.
- 3 - Scan-00000
After contrast administration, there is no focal area of abnormal enhancement in the pituitary gland per se.
1. An approximately 3.5 x 2.0 x 2.0 cms sized well-defined, lobulated, extraaxial, nearly uniformly enhancing mass lesion in the prepontine cistern to the left of the midline, extending into the Meckles cave and the left parasellar region as described is not specific for a single etiology. This most likely represents a nerve sheath tumor arising from the left fifth nerve.
2. Altered signal in the subcortical white matter in the frontal regions bilaterally most likely represent ischemic lesions.
3. The pituitary gland appears normal.