Article Figures & Data
Figures
- Fig 1.
MR image of a 53-year-old man obtained 3 years and 1 month after surgery. A 3-mm-thick FSE T2-weighted image obtained at the level of the inferior cerebellar peduncle shows a tiny area of hyperintensity in the left dorsal portion in the brain stem (arrow).
- Fig 2.
MR images of a 52-year-old man obtained 1 year and 3 months after surgery.
A, A 3-mm-thick FSE T2-weighted image obtained at the level of the middle cerebellar peduncle shows a focal hyperintensity at the right lateral angle of the fourth ventricle in the brain stem (arrow).
B–D, Alternate CISS MR images show that the hyperintensity is contiguous (arrows). The lower end of the hyperintense area is located more anteriorly and deeper on the fourth ventricle floor, and the upper end is more posteromedial.
- Fig 3.
MR images of the patient in Fig 2 obtained before surgery.
A, FSE T2-weighted MR image shows a large cystic schwannoma. The fourth ventricle is compressed by the tumor, and the tiny area of hyperintensity can be seen at the same site (arrow).
B, A CISS MR image shows the hyperintense area more clearly (arrow).
- Fig 4.
MR image, obtained 13 months after surgery, of a 46-year-old woman with a large cerebellopontine angle meningioma. A 3-mm-thick FSE T2-weighted image obtained at the level of the middle cerebellar peduncle shows atrophic change of the right middle cerebellar peduncle and right cerebellar hemisphere, with a dilated fourth ventricle secondary to infarction in the right anterior inferior cerebellar artery distribution (distal AICA syndrome). Most of the meningioma was removed, but a residual tumor is seen in the enlarged right internal auditory canal as an isointensity lesion (arrow). No focal hyperintensity lesion is observed in the dorsal brain stem.
Tables
- Table 1:
Clinical and MR features of the 6 patients with vestibular schwannoma showing a focal hyperintensity in the dorsal brain stem
Patient No./Age (y)/Sex Side Tumor Size (mm) Internal Architecture Distance from Median Sulcus (mm) Depth from Floor of 4th Ventricle (mm) Section No. Showing Hyperintensity on CISS Initial Symptom Period of Postoperative MR Imaging after Surgery 1/24/F Left 25 × 30 × 14 Solid with a central small cyst 7–8 2–3 5 Tinnitus, ear fullness 2 y 11 mo 2/30/F Right 17 × 20 × 16 Solid with several small cysts 7–8 2–4 5 (Head trauma) 5 y 4 mo 3/47/M Left 20 × 30 × 18 Cystic > solid 7–9 3–6 5 Tinnitus 5 mo 4/52/M Right 39 × 50 × 36 Mainly cystic 5–7 2–4 5 Facial dysesthesia 1 y 3 mo 5/53/M Left 32 × 35 × 32 Mainly cystic 8–9 1–2 6 Hearing loss 3 y 1 mo 6/54/F Right 21 × 21 × 15 Solid 7–11 2–4 6 Dizziness 2 y 1 mo Note:—CISS indicates constructive interference in steady state axial imaging.
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