1 year follow-up MRI report -- I might have a schwannoma on the other side??

[kippy6]

I had my follow-up MRI last Friday. I received the MRI report in the mail today per my request. This time (as opposed to last year), I had to go to a different office so that they could use a different kind of MRI machine on me...I think it can get better pictures.

Please help me decipher the medical jargon:

Findings:  (I'm not going to list all the findings, but I will list one strange thing that was on the list...)
Within the brain, there is no evidence of hemorrhage, abnormal enhancement, or herniation. There is a single subcentimeter hyperintense T2 focus within the subcortical white matter of the left frontal lobe on axial T2 image 19, which is nonspecific. Corpus callosum is intact. Diffusion weighted images are negative for acute infarction. Pituitary gland is not enlarged.

Impression:
1. Status post right mastoidectomy and postoperative changes involving the mastoid air cell region/temporal bone. There is not abnormal enhancement on this side indicate evidence of recurrent underlying mass lesion.
2. Left internal auditory canal is unremarkable. There is a tiny 3.5 mm focus, which appears to enhance on the left in the region adjacent to the junction between the horizontal and vertical portions of the facial nerve and horizontal semicircular canal. This may represent a small schwannoma, but is non-specific and a small area of underlying marrow cannot be excluded. Comparison to outside studies would be of value.
3. Negative for increased intracranial pressure or hydrocephalous.

What do you think? Does this mean I have another tumor now? And what is the comment under Findings which says "There is a single subcentimeter hyperintense T2 focus...?" ANY comments at all would be greatly appreciated.

[sgerrard]

For what it is worth, I'm not a doctor, so take it with a grain of salt...

My first MRI report includes a finding of "one or two focal areas of white matter hyperintensity involving the subcortical and deep white matter...", with a corresponding impression of "minimal nonspecific white matter changes."

I take it to mean "duly noted, in case there are more next year, or they start being specific, otherwise no cause for alarm", or something like that.

The other item is in the wrong place for an acoustic neuroma, it is more in the area of a facial nerve neuroma, I think. The radiologist writing the report can't say if it is a neuroma (a.k.a. schwannoma), or a bit of bone marrow, and says it is small - in other words maybe, maybe not. You ENT or neurosurgeon can tell you if they think it requires further investigation now, or waiting until your next MRI to see if anything is actually happening there.

So you are getting some blips on the radar, but nothing definitive. See what your ENT thinks.

Steve

[kippy6]

sgerrard - Thanks so much for your common-sense perspective. I appreciate that. I live in Georgia. I had my MRI on July 27th. The MRI facility in GA said they'd mail the new films to Dr. Brackmann (California) that day. They said he should have the films by Wed, August 1st. I received my MRI report in the mail on Thursday, August 2nd. Today (Friday, August 3), I call Dr. Brackmann's office, and the nurse said they haven't received the films yet. The nurse at HEI said that the MRI facilities almost never mail the films when they say they will... I guess I'll call the MRI facility on Monday....

In the meantime, I'm curious to know about the tiny 3.5 mm focus that they say MAY represent a small schwannoma. Anyone had a similar report with "appears" "may" and "non-specific" in regards to a schwannoma or neuroma? What ended up happening? The people at the MRI facility had both my films from last year and the new ones. I don't understand why they couldn't tell by looking at my old films.

BTW, the kind of MRI I had this time was a Fat Suppression MRI w/and without contrast. If I understand correctly, these MRI machines can see more details than normal MRI machine. Is this true?

[sgerrard]

When I first had my MRI, the ENT asked me to come by and take the films to the surgeon I saw next. He said he never looks at film anymore, he had already reviewed the MRI over the internet, through secured websites. And he expected  I would have a CD with the images, not the actual films. So I am surprised that they don't just electronically send the MRI to HEI for you.

I haven't heard of a Fat Suppression MRI, but mine was w/without contrast, which is definitely more sensitive for identifying neuromas. If the first MRI was a different type, it would make comparing the two difficult, because something might have been there all along, but only shows up on the more sensitive MRI.

Steve

[kippy6]

Sgerrard - I know, I wish they'd send it electronically as well. I think Dr. Brackmann requested the actual films though. Regarding the Fat Suppression MRI...I tried to make an appt. at the same MRI facility I used last year. They said I'd have to go to a different location, and use a different machine, as this time I needed a Fat Suppression MRI. (I may not have the term exactly right). I never realized there could be a difference in MRI machines. I thought they were all the same.

I appreciate your comments. I'm trying to be level-headed. It's hard to wait.

[sgerrard]

No, you got it right, Fat Suppression is indeed an aspect of MRIs. Being a Googler, I had to look it up, and found this tasty technical site:

http://www.users.on.net/~vision/papers/fatsup/fatweb.htm

which contains, amidst all the diagrams, the following gem:

"Bright fat in Turbo Spin Echo sequences"

"There are two reasons why fat appears bright in virtually all sequences that rapidly apply multiple RF pulses; Magnetization Transfer (MT) effects and J-Coupling. The multiple RF pulses act as off-resonance MT pulses, saturating the bound pool of protons. MT induced signal loss occurs in most stationary tissues but not much in fat, leaving it relatively brighter. The more significant effect is based on a phenomenon know as J-coupling or Scalar Coupling."

That gives me a warm and fuzzy feeling about Fat Suppression MRI; how about you? 

And yes, it is indeed hard to wait. Won't be long now...

Steve

[kippy6]

Dr. Brackmann said not to worry. I don't have another AN. It is just a spot, and if everyone in the world had MRI's of their brain, they'd probably have a spot on their scan as well. The spot doesn't mean anything, and he said not to worry.

So, I'm going to take his advice. The spot does appear to be in the correct location for an AN to develop. I just wonder how many people had a spot, which later developed into an AN??

Thanks,

[nancyann]

I sure hope you're right - I just picked up my 1 year MRI result in the mail - as I'm driving to work I start reading it at the stop lights - it says there's a 1.7 cm x 1.3 cm residual tumor mass !!! -I am trying hard not to FREAK OUT!!!   I made an appt. for tomorrow with my otoneurologist, & am trying to get thru to my PCP for an auth # (figures - the auth. I had with him ran out 9/14).

[Omaschwannoma]

Nancyann,

I pray the "official word" from your otoneurologist comes back as mine did at my one-year MR....."I've reviewed the films and do not agree with the radiologists report, what they see as a recurrant tumor is the fat packing."  Hmmmmm?!  My 3-year-post-op MR is due this December and I'll feel much better then.  I can't believe you read your report while in the car!  I waited to get home when I read mine I broke down in a screaming sort of cry that brought my husband running into the other room.  I hope you get your answer "rapido" Nancy and again, I pray the report is wrong. 

[nancyann]

Karen, cheryl & Patti:  Hey guys:  thank you soo much - I hope you're right Karen & that's just what it is - I can't believe it could grow that fast!!  Of course after I parked my car at work I cried my little eye(s) out!!!  Let's keep our fingers crossed - maybe that's why dr. telischi didn't say anything to me when he saw the CD of the 1 year MRI - he knew it was the packing (Ihope I hope...).

[kippy6]

Hi NancyAnn,

Were your first MRI (pre-surgery) films made available to the radiologist this time? It is important for the radiologist to have 2 sets of films (the films before your surgery AND the films 1-year post op films). My radiologist made an addendum to my recent MRI report after receiving the old (before surgery) MRI films of my AN. He received the old films about 3-5 days AFTER reviewing my recent 1-year post-op films! The first report he wrote was scary! I liked his addendum better!

I'm with Arushi on this. Nancy Ann, try not to worry... Bless your heart! I would hope that if it is truly a tumor, that your doctor would have called you right away (the day you had your MRI). The first time I found out I had an AN tumor last year, I went to have my very long MRI. Took about 1 hour to complete the MRI, and then 30 minutes later I walk through my kitchen door, and my child says the ENT called, and to call them as soon as possible... I had to go back to the doctor's office that day to get the bad news. Anyway, I think that doctors USUALLY contact you if there is something big going on. I would think it is standard protocol for a radiologist to contact the patient's doctor immediately if a substantial tumor noticed. Are there any radiologists out there who know what standard protocol is for this kind of thing?

[nancyann]

Hi Kippy:  Yes, the radiologist was comparing the pre-surg MRI to the 1 year post op.   I have a feeling it IS the fat packing that made him/her think this.  I see my otoneurologist today, so I'll have a definite answer.   Always good thoughts,  Nancy

[nancyann]

Update:  Hi everyone:  okay, I saw my otoneurologist, who is very sure it's the fat packing, but he will have a specific neuro-radiologist review the films with him just to make sure.  Well, I thank-you guys for deflating my anxiety yesterday !!! 
In the meantime, my doc tells me he was at a mtg. & was talking with another doc whose wife happens to be a plastic surgeon who is seeing great results with her cross-nerve grafts, & she will be publishing re: these soon.  He knows I'm not interested in anymore 'nerve' surgeries, but 'just in case' gave me her phone # - I left a message on her office voice mail telling her my situation & asking if I have the sling procedure can she still do a cross graft after this.   It's strange that I wouldn't have gone back to my doc had I NOT gotten the MRI report, & that he tells me about this other doctor.  Well, we'll see......

[Cheryl R]

 I am so very happy to hear your news.      I was hoping that we were right and hope it continues to be right!                    I hope you get further info on the facial procedure as a possibilty for you.
       Have a super day!                           Cheryl R

[nancyann]

Thanks Cheryl (& Patti & Karen (Arushi)) - you guys came to my 'emotional rescue'  (Rolling Stones)