MEMORIAL SLOAN KETTERING HOSPITAL FOR CANCER
Name: CRISTIAN, RIVERA
Age: 4 years
Sex: M
Exam: MRI OF THE BRAIN
Completed on: 01/29/2007
CLINICAL STATEMENT: Brain neoplasm. Cranial nouropathies. Mr spectroscopy to determine grade of tumor.
TECHNIQUE: #MRI of the brain was performed with and without gadolinium according to standard departmental brain protocal #1 Mr spectroscopy was not performed.
FINDINGS: Again There is an expansile mass involving the brainstem centered at the level of the pons. The lesion is occentric to the left measuring approximately 5.6 x 3.8 cm at the level of the pons. It extends cephalad to lower midbrain and caudally to involve medulla and the cericomedullary junction....Note is made of mass-effect on the fourth ventricle which is moderately effaced. The ventricles are slightly prominent without evidence of obstructive hydrocephalus...There is no nodular enhacements within the lesion. The mass is most consistent with diffuse brainstem glioma. No definate abnormalities are identified supratentorially. The diffusion weighted images demonstates no evidence of acute infraction. There is inflammatory mucosal thickening within the developing parasal sinuses.
IMPRESSION: Expansile brainstem mass consisten with diffuse brainstem glioma, as described.
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Completed on: 04/23/2007
HISTORY: Pontine glioma. Status post radiation therapy.
TECHNIQUE: #1head without and with intravenous contrast (gadolinium). Additional single voxel and multivoxel CSI (spectroscopy) TE 144 utilizing PRESS technique with attention to the brainstem lesion was performed.
FINDINGS: Again identified is a nonenchacing infiltrative expansile brainstem-pontine mass extending form the plan of the midbrain on the left caudally throughout the pons and just into the medulla has decreased in overall extent when compared to January 29, 2007. The expansile component extending into the prepontine cistern has decreased slightly. This is less mass effect upon the fourth ventricle. There is a patchy region of enhancement within this lesion which actually appears to be vascular and probably represents a incidental development venous anomaly, venous angioma. No new or suspicious appearing enhancement has developed.
Review of the spectroscopy through this lesion demonstrates a elevated choline to creatinine ratio with a depressed NAA peak compatible with tumor. No new lesions have developed. There is no hydrocephalus.
IMPRESSION: Internal improvement in the brainstem glioma when compared to January 29, 2007
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Completed on: 05/17/2007
HISTORY: Pontine glioma. Status post radiation therapy. Limp
TECHNIQUE: #1head without and with intravenous contrast (gadolinium). Additional single voxel and multivoxel CSI (spectroscopy) TE 144 utilizing PRESS technique with attention to the brainstem lesion was performed.
FINDINGS: Again identified is a nonenchacing infiltrative expansile brainstem-pontine mass extending form the plan of the midbrain on the left caudally throughout the pons and just into the medulla has remained stable if not slight decreased in overall extent when compared to April 23, 2007. The expansile component extending into the prepontine cistern has decreased slightly. This is less mass effect upon the fourth ventricle. There is a patchy region of enhancement within this lesion which actually appears to be vascular and probably represents a incidental development venous anomaly, venous angioma. No new or suspicious appearing enhancement has developed.
Review of the spectroscopy through this lesion demonstrates a elevated choline to creatinine ratio with a depressed NAA peak compatible with tumor, with choline to creatine ratio not extending of 1.5. No new lesions have developed. Although the ventricles are slightly more prominent when compared to the prior exam, they remain within the range of normal appearing ventricles. There is no hydrocephalus.
IMPRESSION: Stable if not slightly contracted appearance the brainstem glioma when compared to 4/23/2007
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Completed on: 08/02/2007
HISTORY: Pontine glioma. Status post radiation therapy. Limp
TECHNIQUE: #1head without and with intravenous contrast (gadolinium). Additional single voxel and multivoxel CSI (spectroscopy) TE 144 utilizing PRESS technique with attention to the brainstem lesion was performed.
FINDINGS: Again identified is a nonenchacing infiltrative expansile brainstem-pontine mass extending form the plan of the midbrain on the left caudally throughout the pons and just into the medulla has remained stable if not slight decreased in overall extent when compared to May 17, 2007. The expansile component extending into the prepontine cistern has decreased slightly. This is less mass effect upon the fourth ventricle. There is a patchy region of enhancement within this lesion which actually appears to be vascular and probably represents a incidental development venous anomaly, venous angioma. No new or suspicious appearing enhancement has developed.
Review of the spectroscopy through this lesion demonstrates a elevated choline to creatinine ratio with a depressed NAA peak compatible with tumor, with choline to creatine ratio not extending of 1.5. No new lesions have developed. Although the ventricles are slightly more prominent when compared to the prior exam, they remain within the range of normal appearing ventricles. There is no hydrocephalus.
IMPRESSION: Since 5/17/2007 there is a slight interval increase in the size brainstem glioma with slight interval increase in mass effect upon the fourth ventricle. Currently no change in the size of ventricles.
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Completed on: 09/25/2007
HISTORY: Pontine glioma. Status post radiation therapy. Limp
TECHNIQUE: #1head without and with intravenous contrast (gadolinium). Additional single voxel and multivoxel CSI (spectroscopy) TE 144 utilizing PRESS technique with attention to the brainstem lesion was performed.
IMPRESSION: Since 8/2/2007 there was no growth or shrinkage. Tumor stayed stable.
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Completed on: 10/30/2007
HISTORY: Pontine glioma. Status post radiation therapy. Limp
TECHNIQUE: #1head without and with intravenous contrast (gadolinium). Additional single voxel and multivoxel CSI (spectroscopy) TE 144 utilizing PRESS technique with attention to the brainstem lesion was performed.
IMPRESSION: Since 8/2/2007 there was no growth or shrinkage. Tumor stayed stable.
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Completed on: 12/14/2007
HISTORY: Pontine glioma. Status post radiation therapy. Limp
TECHNIQUE: #1head without and with intravenous contrast (gadolinium). Additional single voxel and multivoxel CSI (spectroscopy) TE 144 utilizing PRESS technique with attention to the brainstem lesion was performed.
IMPRESSION: Since 8/2/2007 there was no growth or shrinkage. Tumor stayed stable.
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Completed on: 2/28/2008
HISTORY: Pontine glioma. Status post radiation therapy. Limp
TECHNIQUE: Beginning on Thursday, 2/28/08, Cristian began a new treatment. A combination of Bevacizumab and Irinotecan are taken intravenously two times in a 30 day period.
IMPRESSION: New treatment was prompted by tumor growth. On his previous medication, Temsirolimus, Cristian responded well for the first four months of treatment. From September - December of 2007, Cristian's MRI's showed no tumor growth. This was very promising, however on January 30th, 2008, Cristian's MRI showed growth. Prior to this MRI, we noticed a regression in Cristian's physical abilities. He started walking with a limp, and had slight loss of vision and laziness in his right eye. These were the symptoms that initially led us to discover Cristian's condition. Due to the change in Cristian's physical condition and growth in his January MRI, doctors ordered that he get his February MRI earlier than scheduled. Results of the February MRI showed even more growth when compared to the January MRI. Due to this growth, doctors immediatly took Cristian off of Temsirolimus and recommended the new combination treatment of Bevacizumab and Irinotecan.
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Completed on: 4/14/2008
HISTORY: Pontine glioma. Status post radiation therapy. Limp
TECHNIQUE: MRI of the brain, with and without gadolinium, protocol #1
IMPRESSION: When compared to the two most recent prior studies dated
1/30/2008 and 2/19/2008 there has been a marked decrease in the
volume of enhancement. On the prior study, the maximal axial
dimensions of the enhancement measured 2.7 x 2.6 cm. On the current
study the area of enhancement measures 1.7 x 1.0 cm. In addition, the
intensity of this enhancement is much less. The axial dimensions of
the nonenhancing tumor has also decreased from 5.2 x 6.1 cm to 3.6 x
5.0 cm. The volume of abnormally increased FLAIR/T2 signal intensity
has also decreased. There is still residual mass effect upon the
fourth ventricle. However, there is no evidence for hydrocephalus. No
abnormal FLAIR/T2 signal intensity or enhancement is seen
supratentorially.
The sinuses are well developed and well-aerated. The orbits and
nasopharynx are unremarkable.
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