MRI with surprise contrast and results

So, that was fun!  I showed up to the imaging center for my MRI and was surprised with having to get contrast dye placed in my veins.  It was not near as bad as CT contrast!  I was in a closed MRI.  It wasn’t bad… I just kept my eyes closed.  I fell asleep twice.  The noises were loud whirring, jackhammery, mechanically vascular sounds that somehow calmed me.  Truth be told, I have way more going on in my life to worry about this.  Avoidance?  Nah.  Apathy?  Not by definition.  We just won’t go there right now.

Anyway…

So today I received my results.  The big concern was a pituitary gland tumor.  Yikes.  Mostly easily treatable, but yikes nonetheless.

And the verdict is…

NO PITUITARY ADENOMA!  Huzzah and yay all around!

But wait, there’s more!  And I promise I’ll get to that!

A few people remember me getting an endoscopy after some violent tummy trouble in November 2012.  My doc was sure it was my gall bladder.  I had an ultrasound, HIDA scan, and the endoscopy.  Gall bladder = fine.  However, I had crazy H Pylori running around my stomach, gastritis (probably atrophic according to the doc), GERD, and wait for it… Barrett’s Esophagus.

Say whaaaat?

The only heartburn I felt was twice while pregnant with Kavan.  I don’t think I ever got heartburn with Keelyn.  I’m a “silent sufferer” and my LES (lower esophageal sphincter) doesn’t care to work so much, if at all.  Barrett’s is a “result” of GERD where the esophageal lining is hurt by the reflux enough to change its structure to be more similar of stomach lining.  This helps protect the esophagus in a sense, but also makes it susceptible to some nasties that won’t be named but starts with the letter “C”.  Greater chance of it – but not like it’s gonna happen for sure.

That rabbit trail was brought to you by the point of:  Amanda has had testing before for one thought illness/problem, but that once thought illness/problem wasn’t the culprit.

See, I told you I’d get back to the MRI!

So, those results.  Not what I expected.  That’s a good and not so good thing.  Again, my energy is focused elsewhere – so that’s “good”, right?

The following is the actual interpretation from the radiologist at the imaging center.

Currently no intracranial mass, mass effect, or extra-axial collections are identified.  The ventricles are symmetric about the midline.

There are several punctate foci (lesions) of increased signal on the long TR sequences in the white matter.  These findings are fairly nonspecific with fairly broad differential considerations (well, that’s fairly vague) and can be seen in patients with migraines.  There is a small focus of porencephaly (WHAT THE WHAT?!?!  Look it up…!) in the right frontal lobe in a subcortical location with minimal surrounding hyperintensity consistent with gliosis (again… SAY WHAT?) and this is likely related to some previous brain insult.  No mass effect or edema or abnormal contrast enhancement are demonstrated in association.  
I appreciate no evidence for any acute infarction or cerebrovascular distribution infarction  No significant areas or foci of abnormal contrast enhancement are demonstrated.  You appreciate it?  Me too buddy, me too.  Also, infarction is a word that always makes me giggle.  It’s fun to say – or think.
The pituitary demonstrates homogeneous enhancement.  No focal pituitary lesions are demonstrated.  The pituitary stalk is midline.  I appreciate no supra or parasellar lesions at this time.  Aww, I’m appreciated!  The cavernous sinuses symmetrically opacify.
Now, here’s where things get a bit interesting again…

Evaluation of the paranasal sinuses reveals the right sphenoid sinus to be nearly completely opacified.  (Oh good…)  Some of the material within the sinuses at T1 and T2 hypointense are consistent with inspissated mucous (Gross!), though fungal sinusitis could have this appearance.  The walls of the sinuses appear grossly intact.  There is mild mucosal thickening in several ethmoid air cells.  There does appear to be small retention cysts and/or polyps within the right maxillary sinus superiorly and inferiorly and mild mucosal thickening throughout the right maxillary sinus.  There is minimal abnormal signal in the mastoids on the right, likely indicating inflammatory mastoid disease.

That should be fun to get out…

Impression:

1.  White matter changes are present which are nonspecific but certainly can be seen in patients with migraines.

2.  Small area of porencephaly and gliosis (Wow again…) in the right frontal lobe likely indicating some previous brain insult.  I do not appreciate any associated acute pathology edema, mass effect, or enhancement.

3.  Unremarkable pituitary.  How rude!  I think it’s quite remarkable!  🙂  

4.  Extensive mucosal sinus disease (Sounds disgusting) involving predominantly the sphenoid sinus, with involvement ofthe remainder of the paranasal sinuses as above delineated.

End Scene.

Well… oh, my PCP wrote on the front of the report that was sent to me “Bad sinus disease – to Dr. ******* Rest looks ok”
So, onward to the ENT doc.  I’ll see my ophthalmologist on the 23rd and will talk about a neurology referral.  Though the “rest looks ok”, I’m concerned that I have surprise lesions, porencephaly, and gliosis.  Hopefully I’ll get to talk to my PCP before then, but we’ll see.  🙂  I’m good either way.  🙂
That’s what I know for now!  Updates as I get ’em!
Blessings,
Mojo
 
 

 

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