GADOLINUIUM MRI REPORT INTERPRETATION

[tbodh]

\My father is 67 years old with complete hearing loss in his right ear, very susceptible to colds, and has started to forget things, does the MRI suggest something like that(sinusitis? other stuff - alzhemiers?). The ENT specialist has advised gamma knife treatment for the neuroma. is that safe, should one go for it?
My dads MRI report is as under, would like help in understanding more on this.Thanks in advance

MRI BRAIN(CONTRAST)
STUDY PROTOCOLS
FLAIR T1W AND FAST SPIN ECHO T2W HIGH RESOLUTION AXIAL IMAGES OF BRAIN WERE OBTAINED ON A DEDICATED PHASED ARRAY HEAD COIL USING 1.5 TESLA TWIN GRADIENT SYSTEM AND CORRELATED WITH T2W SAGGITAL, CORONAL(FAT SAT) AND T2 FALIR AXIAL AND DIFFUSION AXIAL IMAGES, SERIAL T1 WEIGHTED AXIAL, CORONAL AND SAGITTAL IMAGES OF THE BRAIN WERE OBTAINED AFTER ADMINISTRATION OF I.V(GADOLINIUM) CONTRAST

SUPRATENTORIAL
There are a few discrete and punctuate T2W/FLAIR hyperintense foci scattered in the bilateral periventricular sub cortical and deep white matter in temporal-trigonal and frontal-parietal lobes; Non-specific White Matter Hyper intensities (WMH’s) and common etiology include Lacunar Ischemia and HIE Vasculopathy and admixed perivascular (Virchow-Robin) spaces; Et at Lacunaire and ‘crible.
Rest of the cerebral parenchyma is normal in signal intensity with maintained grey and white matter differentiation.
Rest of bilateral basal ganglia and thalami are normal in volume and signal intensity.
Ventricles are borderline prominent(Ex Vacuo) with peri-ventricular subtle Intra-cerebral Arteriosclerotic/ Leuko-encephalopathy changes.Septum is in midlines. Basal cisterns and Sylvian fissures are prominent.
POSTERIOR FOSSA
Brainstem is central and normal in signal intensity. Fourth ventricle is central and normal. Cerebellum is normal in signal intensity. Major intracranial flow voids preserved.

THERE IS A FOCAL LOBULATED LESION OF SIGNAL ALTERATION ENCOMPASSING THE CISTERNAL AND CANALICULAR SEGEMENTS OF THE RIGHT VII/VIIITH NERVE COMPLEX AND TRANSENSION OF PORUS ACOUSTICUS CUMULATIVELY MEASURING APPROX. 12.4X11.6X10.2 MM IN SIZE APPEARING ISO-HYPOINTENSE ON T1W AND ISO-HYPERINTENSE ON T2W IMAGES WITH INTENSE INHOMOGENOUS ENHANCEMENT ON POST-GAD IMAGES; RIGHT VESTIBULO-COCHLEAR (ACOUSTIC) SCHWANNOMA/NEUROMA.
There is flow vascular voids(AICA/SCA) seen juxtaposed the Cisternal segments of the Right VII/VIIITH nerve complex and bilateral Vth (Trigeminal) nerves; Variant.
THERE IS RHINO-SINUSITIS WITH RIGHT WARDS DEVIATION OF NASAL SEPTUM.

DIAGNOSIS:
MR IMAGING OF BRAIN (CONTRAST) REVEALS THE FOLLOWING SALIENT FINDINGS:
THERE IS A FOCAL LOBULATED LESION OF SIGNAL ALTERATION ENCOMPASSING THE CISTERNAL AND CANALICULAR SEGMENTS OF THE RIGHT VII/VIIITH NERVE COMPLEX AND TRANSENSION OF PORUS ACOUSTICUS CUMULATIVELY MEASURING APPROX 12.4X11.6X10.2 MM IN SIZE APPEARING ISO-HYPOINTENSE ON T1W AND ISO-HYPERINTENSE ON T2W IMAGES WITH INTENSE INHOMOGENOUS ENHANCEMENT ON POST-GAD IMAGES; RIGHT VESTIBULO-COCHLEAR (ACOUSTIC) SCHWANNOMA/NEUROMA.
.

[tbodh]

Thanks. Could rhino-sinusitis be a cause for recurrent colds/coughs? Hes 67 years old.

[slightlybroken]

I'm no doctor, or a radiologist tech, but I'll give it a try.

Your father has a brain tumor, called an acoustic schwannoma/neuroma. It is pretty significant in size, measuring 12.4 x 11.6 x 10.2 mm. These neuromas are mostly benign but can put pressure on other cranial nerves. It does mention in the report 7th and 8th cranial nerves. This tumor is the reason for your father's hearing loss, and gamma knife treatment is mentioned as one of the treatment options. Here is what I found about radiation treatment:

"Radiation therapy
Radiation therapy is done in a variety of ways, but mainly by three methods: gamma knife radiosurgery or fractionated stereotactic radiotherapy, with a linear accelerator (linac), or proton therapy. In the gamma knife approach, 201 beams of gamma radiation are focused on the tumor in a single session. The damage to the tumor at the convergence point may cause it to stop growing but usually does not cause it to shrink in the long term. It may cause short-term shrinkage due to necrosis in the tumor. The damage may be to the tumor cells and/or to the tumor vasculature."

More or less, the course of action with the gamma knife is to stop the growth, and possibly shrink the tumor. They will still need to watch your father's condition, afterwards to make sure that the tumor does not re grow.

They do mention that he has Rhino-sinusitis. Rhino-sinusitis is an inflammatory process involving one or more of the paranasal sinuses that usually follows an allergic reaction or viral upper respiratory infection. In some cases, rhino-sinusitis may occur due to increased production of bacteria on the surface of the sinus cavities.

He has a few scattered nonspecific WMH in other areas. They aren't sure of the exact cause. One that I do understand is Lacunar Ischemia. This could be a stroke that has healed, but like I said they don't know the exact etiology of what caused these white matter hyper intensities and they do mention other causes as well.

I hope this helps.

[Nancy T]

Whoops, I didn't see that you'd posted your father's age here. I think that older people often have "spots" in their brain; ask his doctor whether the findings other than the acoustic neuroma are significant, given his age. (Probably not; the radiologist would have mentioned them in the summary.)

There is a great acoustic neuroma board at the following site:

http://www.anausa.org/forum/

They can answer lots of questions and offer support.