MRI OF THE BRAIN WITHOUT CONTRAST
DATE OF STUDY: MM/DD/YYYY
INDICATION FOR STUDY: Unusual new and prolonged headaches.
TECHNIQUE AND FINDINGS: FLAIR imaging in both axial and sagittal planes suggests some high signal within the pituitary gland itself. Although the posterior pituitary gland can produce some higher signal, the amount that is seen is slightly greater than is commonly noticed. We would suggest that the patient return for a dedicated pituitary study, which is performed with and without contrast using thin section imaging, should there be a clinical and laboratory concern of the pituitary gland itself.
The size of the pituitary gland is upper limits of normal. The unusual signal could indicate that there is some microadenoma or perhaps another insult to this area but usually that would be accompanied by other laboratory changes.
The remaining portion of the examination suggests a small amount of ethmoid sinusitis but is otherwise within normal limits. There is no mass or mass effect otherwise suggested. No territorial large vessel insult or small vessel insult or white matter demyelination is present.
The craniocervical junction is within normal limits. The brainstem is intact.
IMPRESSION:
1. There is a questionable area of slightly higher signal within the pituitary gland than is commonly seen. Although the overall size is upper limits of normal, this can sometimes be seen with various types of insult, including a microadenoma. Should there be clinical and/or laboratory abnormality with regards to pituitary function, one might want to proceed with a dedicated MRI study of the pituitary gland for which contrast is typically used.
2. Otherwise within normal limits with the exception of some mild ethmoid sinusitis.
MRA OF THE CIRCLE OF WILLIS
The patient has a small or thin basilar artery on this examination. We do see bilateral presence of posterior communicating arteries, which appear to be the primary inflow to the posterior cerebral arteries.
At no point on this examination is there evidence of an aneurysmal change. The middle cerebral, anterior cerebral, and distal internal carotid arteries, and the A1 branches are all felt to be within normal limits. The anterior communicating artery is also unremarkable.
IMPRESSION:
1. No evidence of aneurysmal disease.
2. There is a small or attenuated basilar artery noted on this examination. However, this appears to be compensated by the presence of bilateral posterior communicating arteries feeding into both of the posterior cerebral arteries. This is a normal variant.
MRI OF THE BRAIN WITH AND WITHOUT CONTRAST AND MRA OF CIRCLE OF WILLIS
DATE OF STUDY: MM/DD/YYYY
The patient was extremely claustrophobic and agitated and did move somewhat during this examination. Both a brain MRI and a circle of Willis were able to be performed over time.
BRAIN MRI WITH AND WITHOUT CONTRAST
There is no enhancing mass, mass effect, or midline shift.
There is no large territorial defect, effacement of the sulci, or midline shift.
There are two small white matter areas of demyelination on the FLAIR images just adjacent to the mid section of the right lateral ventricle. No significant edema is noted around them. These could indicate small foci of demyelination from small vessel infarct as well as some other causes. There is one small area of similar white matter demyelination at the gray-white matter junction at the posterior left frontal lobe. This too measures only about 1 to 2 mm.
There is some mild atrophy noted bilaterally.
There is some mild compensation of the ventricular system.
Craniocervical junction is normal. No Chiari malformation is seen. The cerebellopontine angle and IAC regions appear unremarkable.
There is some minimal ethmoid sinus disease.
IMPRESSION:
1. Two small white matter areas of change on the FLAIR images are noted adjacent to the right lateral ventricle in the anterior parietal region. These present with no surrounding edema and no enhancement. They are most likely the sequela of small vessel insult. A similar small density is seen in the posterior left frontal lobe.
2. Mild and diffuse atrophy is present with compensatory enlargement of the ventricular system.
3. No abnormal enhancement. No evidence of mass or significant territorial vascular insult.
MRA OF CIRCLE OF WILLIS
There is some movement artifact.
There is some mild atherosclerotic disease suggested of the basilar artery and both of the distal internal carotid arteries. It is mild and diffuse in both of those areas. No evidence of focal stenosis of significance is seen. No evidence of aneurysmal disease is noted of the basilar artery tip or of the middle cerebral artery, ICA branching distribution, or of the anterior cerebral artery or the anterior communicating artery.
This examination does not demonstrate the presence of posterior communicating arteries. It can be that their flow is so small as to not be detected on MRI.
The flow pattern of the middle cerebral arteries though somewhat attenuated distally and bilaterally is otherwise symmetric and without a focal area of significant narrowing or constriction.
IMPRESSION:
1. Mild atherosclerotic disease of the distal internal carotid arteries bilaterally and of the basilar artery.
2. No focal area of significant constriction or absence of flow. No aneurysmal changes. Both distal middle cerebral arteries do show some attenuation.
