Here's a copy of Paul's latest MRI report.
UNIVERSITY OF CHICAGO HOSPITALS
Disease (ICD9) codes: 191.9' BRAIN CANCER
The patient is a 51-year-old male with a clinical history of known brain tumor. Please evaluate for any changes following chemotherapy and radiation therapy.
Various previous studies are available. Today's study is compared with those examinations.
An initial examination is available from Franciscan MRI dated 7/8/97 which revealed an irregular ring of enhancement in the left medial temporal lobe adjacent to the free edge of the tentorium. At that time, there was mild surrounding edema and minimal mass effect. Within the area of enhancement, there were central areas of decreased signal intensity consistent with cystic change or necrotic change.
A follow-up examination is available from 10/15/97 which revealed that the lesion had enlarged in size, exhibited a multiloculated pattern of enhancement and had an increase in surrounding edema. The mass abutted the tentorium and there appeared to be enhancement along the tentorium as well. On 10/15/97, there was an increase in the mass effect with compression of the left lateral ventricle, but without real evidence of shift of the midline structures.
Today's study is dated 2/4/98 and follows treatment with radiation and chemotherapy. When compared with the study of 10/15/97, there has been a change in the pattern of enhancement. The multiple cystic areas appear slightly smaller than previously, although the rim of enhancement appears slightly more prominent, particularly along the posterior and lateral margin of this lesion and the bulk of the lesion appears to have "shriveled in size" and is possibly slightly smaller than on 10/15/97. There is a new increase in the amount of surrounding edema. Therefore overall the mass effect has increased when compared with previously and now there is additional compression of lateral ventricle and slight shift of the third ventricle with tilting of the third ventricle towards the right side. This is a a new finding. No other enhancing lesions are seen.
Overall, there is a slightly changing pattern in the enhancement as compared to 10/15/97 and the lesion is the same or perhaps slightly smaller than previously.
There is an increase in the amount of surrounding edema and the amount of mass effect when compared with the October study.
Selective films from previous studies will be copied and placed in the patient's folder.
Also identified are areas of increased signal intensity on the short TR images consistent with internal areas of hemorrhage or possibly areas of calcification with parodoxical increased signal intensity.
Also identified is fluid in the left mastoid air cells presumably related to radiation. There are also retention cysts or polyps in both maxillary sinuses.
Continue to: Mar. 4, 1998
Return to: Diary of a Brain Tumor Patient's Wife
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Created: May 24, 1999
Last updated: July 18, 2010