sb/ke/rg/nl
Date : 00.00.00

Name of the Patient : Abc Xyzi lmn / F / 63 yrs.
Referred by : Dr. Abc Xyzshra.
Examination : M.R.I. of the Brain.

CLINICAL PROFILE :

H/O bifrontal craniotomy on 00.00.00.
HP s/o meningioma.
For follow up.

EXAMINATION :

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 STIR coronal images.

After administration of contrast the following parameters were used :

5 mm thick T1 Weighted axial images with magnetization transfer.
4 mm thick T1 Weighted coronal images.
5 mm thick T1 Weighted sagittal images.

OBSERVATION :

There is evidence of a bifrontal craniotomy. Minimal extracerebral (most likely) subdural collection/hematoma is noted at the site of previous surgery with a maximum width of about 4.0 mms.

There is an ill-defined, hypointense lesion on the T1 Weighted images in the cortex and the subcortical white matter in the left inferior frontal and frontal regions bilaterally. This lesion appears hyperintense on the proton and T2 Weighted images. Focal hyperintense signal on the T1 Weighted images which appears hypointense on the T2 Weighted images is noted within this lesion to the right of the midline and may represent calcium /hemoglobin breakdown products. Mild dilatation of frontal horns of both lateral ventricles is noted.
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There is seen an intermediate signal intensity mass lesion on the T1 Weighted images in the region of the ethmoidal air cells bilaterally extending into the sphenoid sinus posteriorly, nasal cavity inferiorly and into the left orbit, medially. This lesion appears predominantly hypointense on the T2 Weighted images. There is resultant erosion of the medial wall of the left orbit and inferior displacement of the left medial rectus muscle and lateral displacement of the left superior rectus muscle nearer the orbital apex. Extension of the lesion into the left orbital apex per se is noted. Mild proptosis of the left globe is identified. The left optic nerve shows normal signal intensity.

Altered signal in the left maxillary antrum most likely is inflammatory in etiology. Altered signal in the left frontal sinus may represent tumor extension/post-operative changes.

There is mild fullness of both the lateral and the third ventricles. The fourth ventricle is normal. There is slight prominence of the cerebral cortical sulci and the cerebellar folia bilaterally. 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 patchy enhancement of the lesion in the ethmoidal aircells, sphenoid sinus and the nasal cavity. Meningeal enhancement in the frontal regions bilaterally may be the sequelae of previous surgery.

IMPRESSION :

1. Post-operative status.

2. Altered signal in the inferior frontal and frontal lobes bilaterally represents gliotic/encephalomalacic changes, the sequelae of previous surgery.
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- 3 - Scan-00004



3. Patchily enhancing mass lesion in the ethmoidal air cells bilaterally, sphenoid sinus, nasal cavity inferiorly and in the left orbit, medially represents residual tumor.

As compared to the previous MRI dated 00.00.00 (scan no.00006), there is no intracranial component of the previously described tumor identified. The lesion in the paranasal sinuses and left orbit remains unchanged.