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Thread: MRI Results

  1. #1
    Newbie New User
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    Oct 2019
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    MRI Results

    Male age 44

    Reason for the exam

    -Very recent right arm and leg paralysis. Sudden onset with dizziness lasting 5 to 6 hours. No facial or speech paralysis, increased sensitivity to light, increased troponin levels peaked 2 hours after incident, decreasing to normal within 24 hours. ECG normal. All vitals normal. Discharged same-day.
    -Random infrequent tinnitus in left ear. Episodes lasting 10 to 40 seconds
    -Infrequent mild migraines primarily with sensitivity to light. Does not medicate.
    -Claims very slight hearing loss in left ear. not tested.


    Medical history

    Bipolar II . Medicated. Stable for over 15 years
    Two seizures, one at age 15, one at age 30.
    Recent supraclavicular fossa lipoma resection, approximately 3 cm x 5 cm x 8 cm.
    Uses chewing tobacco.
    Recent stress test, excellent.
    Recent echocardiogram, excellent.
    Recent CT, heart and vascular, excellent.




    IAC

    In the left CPA there is a 1.2 cm AP x 1.7 cm TV x .09 cm CC mass extending into and expanding the porus acusticus. It is characterized by heterogenous T2 isointense and T1 hypointense signal to grey matter, with several internal cystic regions in the cisternal portion of the mass and adjacent to the cochlear aperture.

    Avid post contrast enhancement is present. There is no apparent enhancement on the cochlea, facial nerve or dura. The lesion abuts the hypoglossal nerve as it exits the brainstem, no significant regional mass effect is demonstrated on the pons. There is no brainstem edema.

    The right CPA– IAC is unremarkable.


    Cervical spine

    The visualized spinal cord is normal in signal and morphology. Increased T2 signal is seen on the first slice of series 3 at the C1 level. No corresponding signal abnormality identified on sagittal images. Dedicated C-spine axial sequences start at the C2 level, making it difficult to exclude abnormal cord signal at the C1/2 level.


    REPORT

    Left cerebellopontine angle and porus acusticus mass, most keeping with a vestibular schwannma.
    Limited assessment of the cord at C1/C2, with questionable signal abnormalities seen in the axial plane.


    My Questions and Concerns :

    T2 isointense and T1 hypointense signal non-contast imaging. This seems back word to me.
    Usually T2 hyperintense with vestibular schwannma. T2 isointense, ???

    Heterogenous mass

    Having several internal cystic regions.



    Any thoughts or comments would greatly appreciated. Appointment with neurologist soon, I would like to have a little more understanding and possibly any questions I should have of him.
    Last edited by DAV44; 10-16-2019 at 03:39 AM.

  2. #2
    Senior User
    Join Date
    Mar 2017
    Posts
    219
    Hi,

    I understand your concern; unfortunately, this is a forum where cancer patients and their loved ones find and offer mutual support and information on cancer topics, but we are not medical professionals.

    Based on your MRI report, it seems the current working hypothesis is for a schwannoma, which is rarely cancerous - and that is good news for you.

    I am afraid your questions will be best answered by your neurologist, whom I understand you are to see within a few days. Perhaps this will provide some answers in the meantime:
    "MRI
    Schwannomas have fairly predictable signal characteristics 7:
    T1: isointense or hypointense
    T1 C+ (Gd): intense enhancement
    T2: heterogeneously hyperintense (Antoni A: relatively low, Antoni B: high)
    cystic degenerative areas may be present, especially in larger tumors
    T2*: larger tumors often have areas of hemosiderin")


    (you can read the whole article here: https://radiopaedia.org/articles/schwannoma or this related, more specific article: https://radiopaedia.org/articles/int...annoma?lang=us)

    Also, it seems there are two types of schwannoma "Antoni A" and "Antoni B", which may enhance differently on MRI:
    "a heterogeneous MR imaging appearance of larger tumors was seen more commonly in lesions with a higher ratio of type B to type A tissue" (see this article: http://www.ajnr.org/content/28/9/1633#sec-6).

    I hope this helps. Best of luck to you.

    PBL
    Last edited by PBL; 10-16-2019 at 08:35 PM. Reason: addendum
    06/2015 - Spontaneous pelvic fracture after 8 years of unexplained left hip pain
    02/2016 - 52 y.o. - Final Dx: Grade 2, Stage 4 Primary Bone Follicular lymphoma
    TTT - 6 R-CHOP21 (03-06/2016) + Maintenance Rituximab (08/2016-04/2018.)
    Currently in remission - Semestrial scans+mris & follow-up appointments with hematologist.

  3. #3
    Newbie New User
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    Thank you for the info and links.

    So far I'm taking the findings and imaging pretty well, trying not to get worked up about it to bad.

  4. #4
    Senior User
    Join Date
    Mar 2017
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    219
    Quote Originally Posted by DAV44 View Post
    Thank you for the info and links.

    So far I'm taking the findings and imaging pretty well, trying not to get worked up about it to bad.
    That's the spirit! Keep your cool - whatever the situation, it makes life easier.

    Do let us know what comes out of your neuro appointment, as you may contribute to help another worried poster down the line.

    Wishing you the best possible outcome,

    PBL
    06/2015 - Spontaneous pelvic fracture after 8 years of unexplained left hip pain
    02/2016 - 52 y.o. - Final Dx: Grade 2, Stage 4 Primary Bone Follicular lymphoma
    TTT - 6 R-CHOP21 (03-06/2016) + Maintenance Rituximab (08/2016-04/2018.)
    Currently in remission - Semestrial scans+mris & follow-up appointments with hematologist.

 

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