MRI of the brain 20.01.2023 — second specialist reading
Diagnostic center
04073, Ukraine, Kyiv,
Stepan Bandera avenue, 17/1
phone: (044) 392 33 93
License of the Ministry of Health of Ukraine
decision No. 1296 dated 01.12.2016
"Medistar" LLC
Consultation on the provided MRI of the brain with intravenous contrast dated
January 20, 2023 (taking into account data from January 13, 2023), MR angiography of the brain
Patient's name: Zherlitsyna Anastasia Stanislavivna
Date of birth: 25.04.1976
Date of examination: 20.01.2023
Date of consultation: 23.01.2023
No. PMDA1525
MRI in dynamics from January 13, 2023.
From the anamnesis - leiomyosarcoma of the uterus T2NxM1. Condition after 4 cycles of chemotherapy according to the Gemcitabine+Docetaxel+Avastin protocol with progression in the liver. Kit mutations have been identified, which is why Pazopanib is recommended (according to the advisory opinion of the oncologist dated 4.01.2023).
According to the MRI data of 13.01.2023, treatment was carried out, against which, according to the relative, the patient's neurological condition improved, however, at the time of the appeal, the relevant medical documentation was not provided.
On a series of MR tomograms of the brain, the previously described diffuse foci of hyperintense MR signal on T2WI and T2blade fark-fl are preserved in the cortical-subcortical parts of both hemispheres of the brain, however, with their moderate regression in the form of some reduction in size, less hyperintense MR signal T2blade dark-fl and with a significant reduction in areas of accumulation of the contrast agent.
Instead, in the previously described pathological area in the left occipital region, the appearance of a focus of intracerebral hemorrhage with the general conventional dimensions of 14x11x18mm, with signs of diffusion restriction and with perifocal edema of the brain substance, up to 10.2mm in width; a small hemorrhagic focus in the right occipital region against the background of the zone of hyperintense MR signal on T2blade dark-fl is currently without dynamics.
The appearance of new foci of hyperintense MR signal on T2blade dark-fl in the cortex of the medial parts of both parietal lobes of the brain is observed, the foci show a hyperintense MR signal on DWI (b=1000), one of the foci in the right parietal lobe with limitation of the diffusion coefficient according to ADC, dimensions of foci on the right (2 foci) 18.7x13.8mm and 12×12.5mm, on the left 7.2×9.5mm. These foci do not accumulate the contrast agent.
Along the course of the subarachnoid spaces in the frontal regions, the areas of hypointense MR signal on SWI, increased on T2WI and T2blade dark-fl are saved, which are not defined on DWI and do not accumulate contrast agent (perhaps the consequences of local SAH or hemorrhagic impregnation).
Median structures without lateral displacement. The lateral ventricles are symmetrical, unchanged in size, the IV ventricle is located along the midline. The demarcation of gray and white matter is clear.
Periventricular zones of leukoaraiosis with a width of up to 2 mm.
VERTE!!!
The corpus callosum, basal ganglia, mesencephalic structures, structures of the posterior cranial fossa, brain stem do not contain areas of pathological changes in the MR signal.
Craniovertebral junction: cerebellar tonsils without signs of prolapse into the large occipital foramen.
Sella turcica: located typically, conventional configuration. The walls are even, the contours are smooth, clear. The funnel of the pituitary gland is located clearly in the center. The pituitary gland is bean-shaped, the upper edge is symmetrical.
Chiasm, optic nerves without features.
Pneumatization of the paranasal sinuses is not disturbed.
During MR angiography, the asymmetry of the diameters of the A1 areas of the ACA is determined with a decrease in the diameter to the right, which may correspond to hypoplasia. A moderate asymmetry of the diameters of the anterior cerebral arteries (D<S) is determined. The anterior connecting artery is normally developed.
In the M1 areas of both MSAs, areas of uneven narrowing of vessels are visualized, which may correspond to vasospasm or vasoconstriction. The MR signal from the distal branches of the MSA is traced. A decrease in the diameters of the distal branches of the posterior cerebral arteries, as well as the A2 area of the right ACA, is determined, possibly due to vasospasm or vasoconstriction.
The internal carotid arteries have a normal course and diameter, are located symmetrically, and are clearly expressed. A sac-shaped aneurysm of the supraclinoid segment of the left ICA with a diameter of 2.6 mm is determined.
The main artery has an usual course and diameter and divides into posterior cerebral arteries, which are not changed.
Conclusion: MR picture of pathological changes in the brain, taking into account clinical data and history, localization and MR characteristics, alternating zones of regression of some foci and the appearance of new foci during dynamic observation in a short period of time (preliminary MRI of the brain from January 13, 2023) , may correspond to posterior reversible encephalopathy syndrome (PRES); should be differentiated with manifestations of cerebral vasculitis. In comparison with the previous MRI examination from January 13, 2023, the appearance of a focus of intracerebral hemorrhage in the left occipital lobe of the brain, foci of acute-subacute ischemia or areas of cortical edema in both parietal lobes of the brain against the background of cerebral artery vasospasm is determined. MR signs of saccular aneurysm (MA) of the supraclinoid segment of the left ICA.
Expedient: clinical and tomographic comparison, MR control in dynamics, observation of a neurologist, consultation of a vascular neurosurgeon.
Doctor: Skorokhoda Anna Orestivna
Dear patient! These research data are not a clinical diagnosis.
You need to give them to your attending physician, who will explain the results of the examination and establish a final diagnosis.
For dynamic observation, notify our staff and provide a disc with a previous study conducted at our institution.
01/17/2023 11:06:39 Protocol prepared by: Kutsenko Viktoria Stanislavivna No 01-20/128 В04 08/05/2020