MRI of the brain

History: 34 year-old male with history of leukemia in 1989, now with
headaches and visual changes.

Comparison: None available.

Technique and Findings:

MR examination of the brain was performed before and after
administration of intravenous gadolinium in the axial, coronal and
sagittal planes using a variety of pulse sequences. 20 cc of
intravenous gadolinium was administered with no complications.

There is a large right frontal mass likely arising extra-axial which
measures 9.0 x 5.8 x 7.0 cm in the AP, mediolateral and
superior-inferior dimensions. The mass has a heterogeneous T2 signal
with areas of both intermediate and high signal intensity. It is also
heterogeneously-enhancing following gadolinium administration, with
more peripheral enhancement and very little enhancement within the
deeper portions. Areas of signal void are seen in the superomedial
aspect of the mass, in the right frontal parasagittal region
representing prominent vessels. Little if any vasogenic edema is seen
surrounding the mass. There is evidence of subfalcine herniation and
approximately 6 mm of right-to-left midline shift. The mass is also
causing compression of the right lateral ventricle and extends
slightly across the midline.There is a small focus of ring-enhancement
compressing the right frontal horn. Areas of increased T1 signal on
pre gadolinium images may represent foci of calcification or subacute
hemorrhage within the mass. This could be further evaluated with CT
examination.
There are also 2 small lesions in the left parasagittal parietal and
left anterior lentiform nucleus with central T2 hyperintensity and
peripheral T2 hypointensity, consistent with cavernous angiomas.
Dr. Judy's office was contacted on 1/9/05 at 3:30 p.m. We understand
the patient has an appointment there next Tuesday 1/17/06.

Impression:
Large likely extra-axial right frontal mass with heterogenous T1, T2
and enhancement characteristics as described , more likely
representing an atypical meningioma/meningeal sarcoma/lymphoma.
Hemangiopericytoma may present a heterogenous appearance as well.
astrocytic tumor less likely due to suspected extraaxial origin.
This mass, as well as 2 cavernous angiomas identified, may have
arisen post CNS radiation for treatment of leukemia, if the patient
has a history of such treatment.

I have personally reviewed the above studies and agree with the
findings.