DEPARTMENT OF RADIOLOGY & IMAGING Lakeshore Hospital & Research Centre Ltd., Kochi, Kerala, India Phone : +91-484-2701032, 94460 06626 E-mail: info@lakeshorehospital.com Web : www-lakeshorehospital.com ry ® & lakeshore’ Global Lifecare lame: jospital 1D: \Sex: \Study Date: [22-Jul-2022 Age: [8 Years [Ref. by: IDR GANGADHARAN VP JARI BRAIN AND MRI WHOLE SPINE WITH CONTRAST Technique: Multiplanar, multisequence MRI including brain MR perfusion and post contrast images obtained. Comparison made with previous MR brain study dated 20 Nov 2019. Findings: Case of anaplastic ependymoma WHO grade Ill. Status post gross total excision. Heterogenously T2 hyperintense left posterior fossa tumor with intralesional cystic areas and hemorrhage now measures 4.0x3.0x3.0cm. Lesion involves left cerebellum, middle cerebellar peduncle and adjacent pons extending into CP angle cistern. High r CBV on MR perfusion (5.7). Perilesional edema and mass effect noted with compression and partial effacement of fourth ventricle. FLAIR hyperintense edema left side brain stem and left cerebellar peduncles. Tonsillar herniation seen with crowding at cisterna magna. Solid tumor component show interval increase in size compared to previous MR study dated 20 Nov 2019. MR perfusion now elevated. Perilesional edema and mass effect has also increased. Findings are suggestive of high grade viable tumor recurrence. 2 intermediate signal band of tissue in left paramedian cerebellum, vermis and foramen Luschka and Magendie region inferiorly extending into cervicomedullary junction. This component is hypoenhancing. Largely unchanged compared to previous study. Leptomineningeal enahcement at CV junction has also increased. Post op changes and gliosis in left cerebellar hemisphere. Left suboccipital craniotomy. Both lateral and third ventricle are normal in size. VP shunt insitu in right lateral ventricle. Supratentorial neuroparenchyma is normal in morphology. Periventricular FLAIR hyperintensity adjacent temporal horns and right and left trigones have increased. Post RT fatty marrow signal change in skull vault, skull base and upper cervical spine. cd ee cas= \ps | Lakeshore’ DEPARTMENT OF RADIOLOGY & IMAGING Lakeshore Hospital & Research Centre Ltd., Kochi, Kerala, India hone : +91-484.2701032, 94460 06626 E-mail: info@lakeshorehospital.com Web : www.lakeshorchospital.com Y. : Jame: (Se MM [Study Date: [22-Jul-2022 lage: Years IRef. by: IDR GANGADHARAN VP Last unfused vertebral body designated as L5 counting from the craniocervical junction. Spinal alignment is normally maintained. The enhancing intradural extramedullary nodule left posterolateral aspect C2 body level less distinct now. Leptomeningeal enhancement at CV junction has increased. Spinal cord is normal in morphology and signal. Conus medullaris is at L1 level. Intervertebral discs return normal signal. No disc herniation seen at any level. SI joints are normal in appearance. IMPRESSION: Known anaplastic ependymoma WHO grade Ill. Post op, post chemo and RT. 1, Recurrent high grade viable tumor left side posterior fossa. 2, Solid tumor component show interval increase in size compared to previous MR study dated 20 Nov 2019. Perilesional edema and mass effect has also increased. 3. Other findings as described. DR. JULIO CHACKO KANDATHIL MD., FRCR, CCT (UK) CONSULTANT RADIOLOGIST Overall imaging features suggestive of disease progression. cn ee