Brain mri reports

Brain MRI Reports

Item to be fulfilled: Ventricular system

Mid line structures

Cerebral parenchyma

Posterior fossa structures

Cortical sulci and extra axial CSF spaces

Para nasal sinuses

Some of the expressions will be changed.

Normal brain without contrastNormal size and configuration of the ventricular system.

No mid line shift.

No intra cerebral or extra axial areas of abnormal signal.

Normal posterior fossa.

OR Normal appearance of the brain stem and cerebellum.

OR No evidence of posterior fossa abnormalities.

Scanned para nasal sinuses are clear.

Normal brain with contrast Normal size and configuration of the ventricular system.

No mid line shift.

No intra cerebral or extra axial areas of abnormal signal or enhancing

lesions.




Scanned paranasal sinuses are clear.

Normal Brain [Trauma]

Normal size and configuration of the ventricular system.

No mid line shift.

No intra cerebral or extra axial hemorrhage or blood degeneration

products.





No fracture lines seen.

NB If fractures are present mention the site (frontal, parietal, …) and type

(fissure, depressed, comminuted,….). when subgalial hematoma is

present it should be mentioned.

Normal Brain (Sinusitis) Normal size and configuration of the ventricular system.

No mid line shift.

No intra cerebral or extra axial areas of abnormal signals.




Partial or total obliteration of ........ sinuses by mucosal thickening showing

low signal in T1 and high signal in T2WI denoting sinusitis [mention the

affected sinuses, maxillary, ethmoidal...,].

Normal brain old age

Symmetrical dilatation of the ventricular system with prominence of the

extraaxial CSF space.

No mid line shift.

No intra cerebral or extra axial areas of abnormal signal.




Scanned para nasal sinuses are clear.

Abnormal BrainTo describe a lesion you should mention the following points:

Definition [well defined, ill- defined]

Shape [oval, rounded, irregular…]

Size [-----x------x------ cm in maximal AP, transverse and cranio

caudal diameters respectively]

Site [intra axial, extra axial, frontal,parietal, …..]

Surrounding edema [If present]

Mass effect which includes

o effacement of the cortical sulci

o Compression of the ventricle

o Midline shift

Signal intensity in T1, T2 and FLAIR images

possibilities include:

Low T1 high T2 [many lesions]

High T1 high T2 [subacute blood]

Low T1 low T2 [vessels, calcium, ...]

High T1 intermediate T2 [fat,...]

Intermediate T1 and T2 [some lesions]

Intra cerebral hemorrhage

A well defined, oval shaped area of blood signal is seen in the …..

[Mention the site of the lesion]. It showed ……….

If blood is recent [intermediate signal in T1WIs with very dark signal

in T2WIs].

Early sub acute blood [high signal in T1WIs and dark signal on

T2WIs] [intracellular met HB].

Late sub acute blood [high signal in all pulse sequences]

[Extracellular met HB].

Chronic blood [very dark signal in all pulse sequences]

[hemosidren].

NB In cases of hematoma with mixed signal either you say

The hematoma showed mixed signal intensities , its major part

showed ….. in T1WIs and ……. In T2WIs, while the smaller part

showed …. In T1WIs and …… in T2WIs.

OR The hematoma showed mixed signal intensities, it's central part

showed …… in T1WIs and ….. in T2WIs while it's peripheral part

showed …… in T1WIs and …. In T2WIs.

NB In case you see a black line surrounding the hematoma you say a rim

of persistent low signal in all pulse sequences is seen surrounding the

hematoma denoting hemosidren formation.

NB A narrow zone of peripheral brain edema my be identified around the

hematoma showing low signal in T1WIs and high signal in T2WIs.

The lesion measures ----x ----x --- cm maximal AP, transverse and

craniocaudal diameters respectively.

The lesion exerts a mass effect in the form of effacement of the cortical

sulci compression of the ipsilateral ventricle contra lateral shift of the

midline structures.

Normal posterior fossa (if the lesion is not in the posterior fossa).


Extra axial hemorrhage A well defined extra axial (elliptical or cresentic shaped) hematoma is seen in

the …… (Mention the site of the lesion).

It showed ……….. Mention the signal changes in T1 and T2WIs as described

with the intra cerebral hematoma however,

The subdural hematoma may show sedimentation level, then you

mention the signal changes of its upper and lower components.

No edema is present in cases of epidurall or subdural hematoma.

No hemosidren seen in there cases [usually].

Sub arachnoid hemorrhage is not assessed by MRI, if so, you can follow

the same items used for CT and remember to change the densities to

signal intensities.

Fresh blood signal is seen smearing the cortical sulci and extra axial CSF

spaces extension into the ventricular system showing dark signal in T2

WIs

NB You cannot see acute subarachnoid blood in T1 WIs

Also mention that the ventricular system is dilated denoting the presence of

communicating hydrocephalus which is usually seen in cases of subarachnoid

hemorrhage.



Brain infarction

A well defined area of abnormal signal intensity is seen in …. [mention the

site of the lesion]. It showed low signal in T1WIs and high signal in T2 and

FLAIR images.

Not included [we do not usually measure the size of the infarct]

No intra cerebral or extra axial hematoma or blood degradation produce .

OR foci of blood signal are seen within the lesion in cases of hemorrhagic

infarction. The blood signal you will see is either

Acute blood [intermediate signal in T1 and dark signal in T2]

[Deoxy HB] OR

Sub acute blood [high signal in both T1 and T2WIs] [extra cellular

met HB].

Normal posterior fossa [if the lesion is not in the posterior fossa].


Lacunar infarction

A small well defined lesion of abnormal signal intensity is seen …..

[Mention the site of the lesion]. It showed low signal in T1WIs and high

signal in T2 and FLAIR WIs and exerts no mass effect on the adjacent

structures.

NB Old lacunar infarct will show low signal in T1 and FLAIR images with

high signal in T2WIs [CSF signal].

NB The same rule is applied for cases with multiple infarcts.

Normal size and configuration of the ventricular system with no midline

shift.

OR Symmetrical dilation of the cerebral ventricles with prominence of

extra axial CSF spaces [in old patients with brain atrophic changes]

No intra cerebral or extra axial hemorrhage or blood degradation products.



Sub cortical arteriosclerotic encephalopathy

Exaggerated periventricular white matter signal intensity in all pulse

sequences denoting sub cortical ischemic changes.

NB Lacunar infarcts may be seen in cases with subcortical arteriosclerotic

encephalopathy, then you describe these infarcts as mentioned before.


shift.

OR Symmetrical dilation of the cerebral ventricles with prominence of

extra axial CSF spaces [in old patients with brain atrophic

changes]

No intra cerebral or extra axial hemorrhage or blood degradation products.


Scanned paranasal sinuses are clear

Space occupying lesion [tumor, abscess,…]Points to be evaluated:

Definition (well defined, ill-defined)

Shape (rounded, oval, irregular, …)

Size----x ----x ----cm in maximal AP, transverse and cranio caudal

diameters respectively

Site (frontal, temproparietal , …, brain stem, cerebellum,..)(Left or right).

Enhancement (no, homogenous, heterogenous, marginal, …)

Surrounding edema (if present)(grade I,II,III) Low signal in T1 and

high signal in T2 WIs

Grade I = area less than 2 cm around the lesion

Grade II = area more than 2 cm but less than 1/2 the cerebral

hemisphere in which the lesion is present.

Grade III = area more than 1/2 the cerebral hemisphere in which

the lesion is present

Mass effect which includes:

Effacement of the cortical sulci

Compression of the ventricle

Midline shift.

Meningioma

A well defined oval shaped SOL is seen in the …. [Mention the site of the

Lesion]. It showed low signal in T1WIs and high signal in T2WIs.

NB Some meningioma shows intermediate signal in both T1 and T2WIs

NB Some meningiomas may contain low signal foci within the tumor mass

representing calcification or signal void blood vessels.

The lesion measures …x…..x….. cm in maximal AP, transverse and

crainio caudal diameters respectively and showed homogenous pattern of

contrast enhancement.

NB An enhancing dural tail may be identified and should be mentioned. A

localized area of calverial bone thickening may be seen at the base of

the meningioma, this area will show persistent low signal in all pulse

sequences [bone sclerosis similar to cortical bone].

The lesion is surrounded by grade --- perifocal brain edema showing low

signal in T1 and high signal in T2 WIs.

The lesion and edema exert a mass effect in the form of -------, --------, -----


Scanned Para nasal sinuses are clear

OR Scanned Para nasal sinuses showed mucosal thickening in the

----,----- (mention the name of the affected sinuses ) denoting sinusitis.

Space occupying lesion Astrocytoma / Glioma A well defined [or an ill – defined], ------[mention the shape of the lesion

oval, irregular,…] shaped SOL is seen in the -----[mention the site of the

lesion]

If the lesion is not enhanced then write [Showing no evidence

of post contrast enhancement]

OR Showing heterogenous (or marginal) enhancement with central

areas of necrosis and breakdown.

OR The lesion is mainly cystic with an enhancing mural nodule

measuring….cm in maximal transverse diameters [mention the

measurement of the cyst and nodule]

The lesion is surrounded by grade------- perifocal brain edema showing low

signal in T1 and high signal in T2 WIs. The lesion and edema exert a

mass effect in the form of -------, ----------, ----------




----,------ (mention the name of the affected sinuses ) denoting sinusitis.

Space occupying lesionMetastatic deposits Multiple well defined SOLs are seen in -----[mention the site of the

lesions] [cerebral hemisphere, both hemisphere, cerebellum, brain stem,

infratentonial, supratentorial, both……].

The lesions range in size between -------[the smallest lesion] and -------[the

largest lesion] and showed -------- [mention the pattern of enhancement.

The largest lesion measures ----- x ----- cm in maximal diameters and is

located in ---- [mention the site of the largest lesion].

The lesions are surrounded by variable degrees of perifocal brain edema

showing low signal in T1 and high signal in T2 WIs. The lesions and

edema exert a mass effect in the form of -------, -------, ------

Normal posterior fossa [if no lesions in the posterior fossa].



--,------ (mention the name of the affected sinuses ) denoting

sinusitis.

NB A solitary metastatic deposit (a patient known to have primary

malignancy is described in the same way as glioma).

CystA well defined cystic SOL is seen in the ------

Ex. Arachnoid cyst is usually present in the inferior temporal region

against the greater wing of the sphenoid bone.

Ex. Epidermoid cyst is usually located in the cerebellopontine angle.

Ex. Dermoid cyst is usually located in the midline and contains fat.

The lesion measures -----X----- cm in maximal diameters and showed low

signal in T1 and high signal in T2 WIs with no post contrast enhancement

[if the patient was injected with IV contrast]

NB Matrix calcifications are not usually seen in MR images

If present they may show low or high signal in T1 [depending on the

mobility of the hydrogen protons], however they will show low signal in

T2 WIs

NB Dermoid cysts usually contain fat, then you have to say that the lesion

contains fat signal which appeared high in T1 and intermediate in T2

WIs.

NB Colloid cysts are usually diagnosed by their location in the midline

plane in the region of the anterior part of the 3rd ventricle.

Colloid cyst can show any signal in T1 [hypo or hyperintense] and any

signal in T2 [hypo or hyperintense] with no contrast enhancement.

Sometimes marginal enhancement is seen in the cyst which shows low

signal in T1 WIs.

Most of the cysts are not surrounded by edema, but they exert a mass

effect, then you have to mention the manifestation of the mass effect in the

form of ------, -----, ------.

NB Colloid cyst may be associated with hydrocephalus due to compression

of the foramina of monro.

NB In cases of dermoid cysts please look for fat globules in the

subarachnoid spaces (sulci, fissures, cisterns) as well as in the

ventricles. If they are present this means that the cyst has ruptured into

the subarachnoid space. Fat globules will appear bright in T1 WIs

NB Hydatid cyst is described following the steps mentioned for glioma.

NB In cases of porencephalic cyst you should mention it's communication

with the ventricular system.

Normal posterior fossa [if no lesions in the posterior fossa].




sinusitis.

Acostic neuroma A well defined SOL is seen in the ------- [left or right] cerebellopontine

angle region extending inside the adjacent internal auditory canal which is

widened [or not]

The lesion measures ---- x ---- in maximal transverse diameters and shows

low or intermediate signal in T1 WIs and high signal in T2 WIs with

homogenous or heterogenous pattern of contrast enhancement.

The lesion is associated [or not] with widening ± pressure erosion of the

ipsilateral internal auditory canal.

Crainiopharyngioma A well defined partly cystic and partly solid SOL is seen in the supra sellar

area with it's main bulk exactly in the midline plane [or slightly to the left or

right of the midline]

The lesion measures ---- x ---- in maximal transverse diameters

The cystic component showed low signal in T1 and high signal in T2 WIs

while the solid component showed intermediate signal in both T1 and T2

WIs with homogenous or heterogenous pattern of contrast enhancement.

NB The cystic component may show high signal in T1 and T2 WIs due to

its high protein content [this finding can help in the diagnosis of

carniopharyngioma]

NB Note that the enhancement in craniopharyngioma is variable, the cystic

component usually shows marginal or no enhancement while the solid

component usually shows homogenous or heterogenous

Enhancement. The foci of calcification may not be seen on MR images.

Usually there is no edema, but mass effect is may be present in the form

of compression of the 3rd ventricle with consequent obstructive

hydrocephalic changes of both lateral ventricles.

NB The lesion may extend inside the sella [best seen in coronal images]or

may extend into the para sellar area or even into the posterior fossa via

the pre pontine cistern (rare)… These extensions should be mentioned

Normal posterior fossa. If the lesion has extended into the posterior fossa

then you can say : No evidence of cerebellar or brain stem parenchymal

lesions




sinusitis.

Space occupying lesionSuprasellar meningioma, dermoid, ….. are described following the steps mentioned for craniopharengioma with

careful attention to the difference in the enhancement pattern and the degree

of mass effect as well as the variable extensions.

Intrasellar pituitary adenoma A well defined intrasellar SOL is seen extending (or not) into the supra

sellar cistern.

The lesion measures ----x ----x ---- cm in maximal diameters and shows

intermediate signal in T1 and T2 WIs with homogenous or heterogenous

pattern of enhancement [mention the type of enhancement].

NB The extensions of the lesion should be mentioned in details specially

the supra sellar extension with obliteration of the suprasellar cistern [if present

best seen in the coronal images], compression of the hypothalamus [also

seen in the coronal images better than CT scan] Extension into the

suprasellar area may also compress and streach the optic chiasm. These

findings should be mentioned in the report.

Parasellar extension into the cavernous sinuses and affection of the internal

carotid arteries should be mentioned

NB Extension into the cavernous sinus is diagnosed by the presence of

tumor tissue lateral to the internal carotid artery.

NB Also mention that the internal carotid artery is patent showing normal

signal void [usual finding].

NB Infrasellar extension with erosion of the sellar floor and invasion of the

sphenoid sinus indicate that the adenoma is invasive then you mention

in the conclusion of the report that the adenoma is invasive and do not

say malignant .

Usually there is no edema, but mass effect may be present in the form of

compression of the 3rd ventricle with consequent obstructive hydrocephalic

changes of both lateral ventricles.

If there is no retrosellar extension, you mention that the posterior fossa

structures are normal


OR Scanned Paranasal sinuses showed mucosal thickening in the


sinusitis.

NB In cases of microadenoma you can say

A well defined small focal lesion is seen within the ----- (left or right) aspect

of the pituitary gland.

The lesion usually shows less enhancement compared o the normal

pituitary tissue and may be associated with the following:

Focal contour bulge of the superior or inferior surface of the

pituitary gland (best seen in coronal images).

Deviation of the infundibular stalk to the opposite (or may be to

the same side)(also seen in coronal images).

The lesion is totally enclosed within the sella with no extrasellar

extensions, no edema, and no mass effect.

Mention that the cerebral parenchyma and ventricles appear normal with

no midline shift, also mention that the posterior fossa

structures are normal




sinusitis.

Intracranial calcification Most of the intracranial calcifications are not usually seen on MR

images

CT is the examination of choice in these cases

In cases of gyral calcification, MR is usually helpful in detection of

associated vascular malformation as well as the enlargement of the

ipsilateral choroids plexus.

AneurysmA well defined rounded ------x----- cm [mention the measurements of the

lesion] lesion is seen in the ------- [mention the site] common sites include:

Suprasellar region to the left or right of the midline plane

Within the sylvian fissure.

In the prepontain cistern [basilar tip aneurysm]

The lesion showed signal void in all pulse sequences denoting patent

lumen.

NB If the lesion is more than 2cm in diameter [gaint aneurysm] it may

show internal thrombosis then you can say that the lesion showed

variable signal intensities in all pulse sequences with characteristic

layring due to turbulence of flow clearly seen in T2 WIs.

The patient lumen show signal void in all pulse sequences while the

thrombosed lumen showed mixture of low and high signals

representing the stages of intraluminal clot [deoxy- Hb, met- Hb,..]


shift.

Normal posterior fossa (if no lesions are present in the posterior fossa ).




sinusitis.

Aneurysm ruptureA well defined rounded ------x----- cm [mention the measurement of the

lesion] lesion is seen in the ------- [mention the site] common sites include:

Suprasellar region to the left or right of the midline plane

Within the sylvian fissure.

In the prepontain cistern [basilar tip aneurysm]

The lesion is surrounded by an irregular shaped area of recent blood

signal [intermediate signal in T1 and dark signal in T2

WIs] measuring -------X ------- cm in diameters

NB We do not usually inject contrast in these cases

The ventricles are usually dilated and may contain fresh blood signal then

you can say: mild or moderate symmetrical dilatation of the supra and

infratentorial cerebral ventricles periventricular edema due to

retrograde

transependymal CSF permeation intraventricular recent blood signal

seen in the ------------ (mention the affected ventricles).

If blood is present in the 4th ventricle then you can say : normal

appearance of the brain stem and cerebellum, but do not write the usual

statement.




sinusitis.

Arteriovenous malformation A well defined area of abnormal vascularity is seen ----- [mention the site

of the lesion] showing serpigenous signal void vascular channels.

Perifocal brain edema may present and a mild mass effect may be also

seen then you should mention these findings.

NB Ischemic areas in the region of the AVM will appear of low signal in T1

and high signal in T2 WIs due to direct shunting of blood from the

arterial to the venous side.


shift.





sinusitis.

Cavernous hemangioma A well defined intraaxial lesion of abnormal signal is seen---- [mention the

site of the lesion]

The lesion showed high signal in all pulse sequences with a well defined

margin of marked hypointensity specially noted in T2 WIs.

The lesion measures -------X ----- cm in maximal diameters and showed no

appreciable post contrast enhancement.

NB Minimal perifocal brain edema may be present around the lesion, then

mention it and say showing low signal in T1 and high signal in T2 WIs.

NB No mass effect exerted by the lesion, if present you can say that the

lesion exerts minimal mass effect on the adjacent structures.

NB In case of multiple lesions, you start to described the largest one [as

mentioned above], then you say multiple similar lesions are seen in ----

[mention the site of each lesion]


shift.





sinusitis.

Intra ventricular lesions

A well defined --------- shaped (mention the shape of the lesion) is seen -----

(mention the site of the lesion).

Possible sites include:

Centered on the region of the 4th ventricle midline posterior fossa.

Within the body or frontal horn of the lateral ventricle (left / right).

Centered at the anterior aspect of the 3rd ventricle.

The lesion showed intermediate signal in T1 WIs with high signal in T2 WIs

and homogenous/ heterogenous pattern of post contrast enhancement

with foci of matrix calcifications. The surface of lesion appeared smooth

or lobulated.

The ipsilateral ventricle is dilated with ± per ventricular edema due to

retrograde transependymal CSF permeation.

NB In cases of choired plexus papilloma , the whole ventricular system is

dilated due to communicating hydrocephalus secondary to CSF over

production by the lesion.

NB If the tumor has penetrated the wall of the ventricle it will initiate brain

edema around, then maliganent transformation is suspected.





sinusitis.

Brain mri reports

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