گزارش پزشک :

BRAIN  MRI

(Without contrast)

siemens MRI ( magnetom altea 1.5 tesla )

Technique:Axial FLAIR  , Axial , sagittal ,  FSE  T2 , coronal T1 .

Findings:

Extra-axial lesion: A large extra-axial cystic lesion, measuring approximately 81 x 51 x 61 mm, is located in the left middle fossa. This lesion exerts compression on the adjacent temporal and frontal lobes, as well as on the left basal ganglia and left midbrain. A midline shift of approximately 6.5 mm to the right side is noted.

Signal characteristics: The lesion shows T1 hypointensity and T2 hyperintensity with mild heterogeneous and “dirty” signal intensity when compared to cerebrospinal fluid (CSF). The heterogeneous signal characteristics raise concern for an epidermoid cyst, which is at the top of the differential diagnosis, with an arachnoid cyst being less likely.

Suspicious extension: Suspicious medial extension of the lesion into the suprasellar cistern is noted.

Recommendation: Due to the heterogeneous signal intensity, correlation with DWI sequences is highly recommended for further evaluation. Although the lesion’s location is typical for an arachnoid cyst, the signal intensity is more in favor of an epidermoid cyst.

Other structures: Normal appearance of the brainstem, cerebellum, and the rest of the brain.

Impression:

Large extra-axial cystic lesion in the left middle fossa, with compression effects on adjacent brain structures and a 6.5 mm midline shift to the right.

The signal characteristics and location suggest an epidermoid cyst as the primary diagnosis, with an arachnoid cyst being less likely.

Further evaluation with DWI sequences is recommended.