Report: Report MRI BRAIN TECHNIQUE: Multiplanar multisequence MRI examination of the brain without and with...

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Report: Report MRI BRAIN TECHNIQUE: Multiplanar multisequence MRI examination of the brain without and with intravenous gadolinium. CLINICAL INDICATION: 54 years old Male GBM COMPARISON M/D/Y: [date removed] MRI, [date removed] CT - - - - - - - - - - - - - - - - - - - - - - - - - - The dominant heterogeneous peripherally enhancing right frontal lobe mass measures approximately 3.6 x 5.5 x 5.5 cm TR AP cc. Previously on CT the margins are less well-defined and measures approximately 4.3 x 5.9 x 5.9 cm and on previous MRI measuring 3.2 x 4.1 x 4.1 cm. There is associated mild peripheral foci of susceptibility artifact which may be related to mineralization or hemosiderin deposition with associated internal T1 hyperintensity. Right frontal burr hole an tract also demonstrates mild heterogeneous enhancement. There are additional foci of nodular enhancement anteriorly superiorly measuring 8 mm series 17 image 18, 1.2 cm laterally and 1 cm medially image 16. A 1.2 cm focus may correspond to small enhancing on previous MRI measuring 0.9 cm previously, the other foci are more conspicuous from previous. Further inferiorly from the dominant mass, there is a abutting enhancement extending into the right basal ganglia measuring approximately 2 x 2.2 x 3.1 cm; perhaps previously on CT measuring approximately 2.3 x 2.3 x 3.4 cm and appears to be more coalescent compared to previous MRI. These lesions demonstrate mild restricted diffusion. There is T2 FLAIR hyperintense changes adjacent to the mass in the right frontal parietal insular lobes which appears to have worsened compared to previous MRI. There is mass effect in the right frontal lobe with effacement of convexity sulci and minimal right subfalcine herniation and mild leftward deviation of the septum pellucidum by 3 mm, slightly more conspicuous from previous MRI however likely not to dissimilar from previous CT. Patchy T2 FLAIR hyperintense changes in the left parietal white matter is similar to previous. MIDLINE STRUCTURES: There is patchy T2 FLAIR hyperintensity of the corpus callosum which appears to be more prominent and confluent at the body compared to previous MRI. Signal changes at the isthmus remain relatively stable from previous,. MAJOR CENTRAL FLOW-VOIDS: Maintained. ORBITS: Unremarkable. PARANASAL SINUSES: Mild ethmoidal and maxillary mucosal thickening. MASTOID AIR CELLS: No effusions. INTERPRETATION: The dominant right frontal enhancing mass appears larger compared to previous MRI however is likely slightly smaller compared to previous more recent CT. There is localized edema and mass effect and mild leftward shift of the septum pellucidum/right subfalcine herniation is perhaps likely not to dissimilar from previous CT. There is additional new foci of enhancement superiorly anteriorly and more confluence of enhancement inferiorly adjacent to the dominant mass compared to previous MRI. The inferior component appears to be more confluent compared to previous MRI, but likely not to dissimilar from previous CT allowing for differences in imaging techniques.