MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

MRI EXAMINATION OF THE HEAD WITH AND WITHOUT CONTRAST

INDICATION FOR STUDY:         Trigeminal neuralgia.

FINDINGS:               Axial, sagittal, and coronal images were obtained on the multiple sequences with and without contrast on the 1.5 Tesla GE MRI.

There is an enhancing mass noted in the cavernous sinus region on the left, which appears to surround the region of the internal carotid artery and extends posteriorly and touches upon the brainstem.  This mass measures approximately at its greatest diameter 2.5 cm in the anterior posterior direction, 2 cm in a craniocaudal direction and approximately 2 cm in a medial lateral direction.  The internal carotid artery signal voids are patent and MRA evaluation was also performed, which show the vessels to be patent.  The sphenoid sinus region shows a small amount of fluid within it appears, but otherwise it is not clear that this lesion penetrates into the sinus region.  There is a small amount of fluid, especially in the right sphenoid sinus region.  The visualized area of the seventh-eighth nerve complex and mastoid air cells and inner ear region on the left show no significant abnormality.  There is question of slight inflammatory changes on the right, somewhat laterally seen on image 5 of series 4, may represent slight inflammatory changes in the anterior mastoid air cells.  The remainder of the brainstem shows no significant abnormal enhancement and the basilar artery signal void also appears patent and without significant abnormality.  The cerebellum and CP angles show no gross abnormality.  The brain parenchyma bilaterally shows no other significant acute area to suggest infarct, bleed, midline shift, or other abnormal enhancing lesion or mass.  The periventricular regions also appear without significant abnormality.  A preliminary report was discussed with Dr. Aldana.

IMPRESSION:         Enhancing mass measuring 2 x 2 x 2.5 cm as discussed above.  This appears in the region of the left cavernous sinus and extends posteriorly to touch upon the brainstem region.  This enhances significantly.  It appears almost isointense on the non-contrast T1 weighted images.  This may represent a meningioma, but other etiologies cannot be excluded.

 

The pituitary appears separate and so does the sphenoid sinus region.  There is a small air-fluid level in the right sphenoid sinus.  The remainder of the brain parenchyma shows no other significant abnormality.  Please see comments above.

Thank you for the referral.

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