MRI BRAIN WITH MR SPECTROSCOPY
Multi planner multi echo MRI study of brain has been performed with contrast enhancement.
Sequences planned are FSE T1W, FSE T2W, FLAIR, and DW images.
Post contrast T1w. Axial T2w localizer taken and Single voxel MR Spectroscopy performed. The voxel of size 2x2cm placed over the lesion. Water suppression obtained was 99% with optimum spectral waveform obtained at short as well as long TE.
A well circumscribed intra ventricular solid soft tissue signal intensity mass with restricted diffusion.
Imagingwise diagnosis suggested is Medulloblastoma.
Description:
A well circumscribed mid line posterior fossa mass completely filling the fourth ventricle.
Size of the mass 43x380mm.
It's a solid signal intensity mass, isointense on T1w and FLAIR , slightly hyperintense to cortical grey matter on T2w. no marked areas of necrosis within the mass or cystic component.
Mild nearly homogeneous enhancement on post contrast study.
Restricted diffusion on Diffusion weighted images implies to dense nature of mass and high nuclear cytoplasmic ratio.
Mild to moderate obstructive hydrocephalus with periventricular ooze of Csf. Generalized effacement of hemispheric cortical sulci implies to marked diffuse cerebral odema.
Obliteration of prepontine cistern and cp angle cistern. Pons significantly compressed. Basilar compressed against Clivus in basilar sulcus.
On MRS;
Peak of lactate at 1.3ppm
No peak of NAA at 2.01ppm
Markedly reduced Creatinine at 3.01ppm
Markedly raised choline at 3.2ppm
Considering age of pt, imaging and MRS findings, location of mass, restricted diffusion on Diffusion weighted images is very typical of a Medulloblastoma.
