MRI Brain + MRA
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Technique: Pre and post contrast study including MRA and postcontrast brainlab sequence performed.
Findings: Irregular cystic lesion centred in the left cerebellar hemisphere measures 3.5 x 4.6 x 3.1 cm (AP x ML x SI). This demonstrates a 15 x 7 mm enhancing nodule at the anterior margin, abutting the pial surface, and contains a single thin internal septation. Thin margin of FLAIR hyperintensity with some subtle signal abnormality in the distorted left posterolateral medulla. Minimal appreciable rim enhancement. No evidence of haemorrhage.The lesion results in positive mass effect upon the medulla and fourth ventricle but without hydrocephalus.
The non-dominant left vertebral artery courses immediately inferior to the mass with the tortuous basilar artery lying anteriorly to and separate from the mass.
Scattered supratentorial white matter T2 hyperintensities are most consistent with moderate for age small vessel ischaemic change. A few punctate foci are also noted within the pons. No other intra or extra-axial mass nor abnormal enhancement, in particular, no abnormal enhancement is seen in the upper cervical cord or retina.
Conclusion: Solitary cystic lesion left cerebellar hemisphere with enhancing mural nodule abutting the pial surface. Appearances are quite typical for haemangioblastoma, however metastasis remains an important differential.