MRI report.

Dear M.D. JT:

Thank you very much for your help. Here's my MRI 2 years after surgery ordered by my endo to make sure the shunt was still working after I complained of slight lethargy.

HISTORY - MRI BRAIN W/WO GADO: EVAL. NO RECURRENT HYDROCEPHALUS
Contrast MR of the brain
History: Follow-up colloid cyst with hydrocephalus

Sagittal and axial T1-weighted sequences were performed and axial T2-weighted sequences were performed. Contrast was administered, axial and coronal T1-weighted sequences were repeated.

Findings: There is a catheter extending into the ventricular system from a burr-hole in the right occipital region. There is no evidence of hydrocephalus. There is a focal area of abnormal high-signal intensity on the left side in the high convexity just in front of the central sulcus. Following administration of gadolinium there is a circular area of enhancement at the site of this abnormal signal intensity. There is no evidence of a mass-effect. The abnormal area enhancement may be the result of previous surgery.

Impression: Postoperative changes with probable enhancement in the operative site from surgery with the catheter extending into the ventricles with no evidence of hydrocephalus.
...
My endo said that this was good news! I thought it was good news because there is no mass effect and no hydrocephalus but was a bit troubled by the "abnormal high-signal intensity" area. What does that mean? Is this just scar tissue? Would you suggest that I inform my neurosurgeon of these images? Could anything be done to correct it?

Thanks again,
Matthew

[CCF-Neuro-M.D.-JT]

Regions of brain enhancement after administration of gadolinium means there is local breakdown of the blood-brain barrier, a protective shield made of capillaries to prevent substances from easily entering the brain.  This can be seen in a number of disease states such as tumor, infection, MS, and postoperative changes due to disruption during surgery. It would be important for your neurosurgeon to go over the films him/herself just to make sure these are indeed just postoperative changes. If they are, then the enhancement will probably go away in time on its own. Good luck.