Hemangioblastoma - late recurrence

MRI brain:

Technique:Pre and post contrast study including MRA and post contrastpostcontrast brainlab sequence performed.

Correlation is made with the external CT dated 27/7/2010.

IrregularFindings:  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 1615 x 67 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.The lesion results in positive mass effect upon the medulla and fourth ventricle but without hydrocephalus.

The non dominant-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. No other intra or extraaxialextra-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.​

MRI

brain (with contrast)

Technique:

Multiplanar, multisequence imaging has been obtained through the brain including pre and post contrast sequences.

Comparison:

MRI December 2014 and January 2011

Findings:

Left-sided occipital craniotomy with expected post-operative change and prominent gliosis of the cerebellar hemisphere is again noted, with an enhancing nodule nestled between the medulla and the left cerebral hemisphere. On today's examination the nodule measures 10 x 12 x 16 mm compared to 9 x 9 x 14 mm in December of 2014 (remeasured) and 6 x 8 x 11 mm in January 2011one year ago (remeasured).

Extensive patchy white matter T2 signal hyperintensity is similar, with no abnormal restricted diffusion. No abnormal enhancement elsewhere, with the remainder of the brain appearing unremarkable.

On T2 axial imaging there appears to be a right-sided middle cerebral artery trifurcation aneurysm (4 x 3 mm). No prior vascular imaging is available.

Conclusion:

1. Enhancing left cerebellar medullary angle nodule continues to slowly growing consistent with recurrent/residual tumour.

2. Probable right middle cerebral artery bifurcated aneurysm. This does not appear to have altered when compared to imaging from 2011 but warrants dedicated vascular imaging (CTA / MRA) if clinically indicated.