MRI Brain and Orbits 1/11/2005

Clinical History:   NF-1 with hypothalamic and optic nerve gliomas.  Follow-up examination.

Technique:  ORBITS:  Tin sagittal and axial T1, thin axial and coronal turbo spin echo T2 with fat saturation, and after uneventful intravenous contrast administration, axial and coronal thin post gadolinium T1 weighted images with fat saturation.  BRAIN:  Axial magnetization transfer, axial turbo spin echo T2, axial flair with fat saturation, axial post gadolinium T1weighted images using magnetization transfer and fat saturation, and echo planar diffusion weighted imaging with additional ADC maps obtained.

Comparison:  MRI 11/9/04


Since the prior MRI examination there has been no significant change in the overall size of the heterogeneously enhancing mixed solid and cystic hypothalamic glioma.  This glioma exerts stable mass effect on the surrounding structures with stable splaying of the supraclinoid internal carotid arteries and cerebral peduncles.

Following gadolinium administration, however, the components of the tumor that enhance have decreased in size both anteriorly and posteriorly.

We note progressive asymmetry of the pons, the left side being larger than the right side, increased since the prior examination.  No enhancement is identified in this region.

Stable spongiform changes are again noted.

There is stable tortuosity of the intraorbital optic nerves with stable enhancement noted on the left anteriorly.

The ventricular system remains stable with no evidence of hydrocephalus.  There is no evidence of an acute infarction or extraaxial collection.

The intracranial flow voids are normal.

Minimal bilateral ethmoid air cell mucosal thickening is noted.  Minimal left mastoid air cell opacification is identified.


No change in the overall size of the hypothalamic glioma with interval decrease size of the enhancing anterior and posterior components of the tumor.

Increased prominence of the pontine glioma on the left.

Stable optic nerve gliomas.