History of pituitary adenoma. Dedicated images of the sella demonstrate enhancing tissue within the right and left posterior aspect of the sella and abutting the right cavernous sinus. Enhancing tissue in the posterior sella measures 6x7 mm (sagittal post gad series 901, image 8/17). There is CSF signal involving the left anterior aspect of the sella with tiny nodule, noted on coronal T2 weighted image 6/15. No findings to suggest tumor within the cavernous sinuses or in the suprasellar cistern. Optic chiasm appears unremarkable. Minimal rightward midline shift of the infundibulum. Compared to comparison study from 11/9/2013, appearance of the sella is unchanged.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. There is mild global parenchymal volume loss with slight prominence of the ventricular system. No findings to suggest hydrocephalus. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Minimal mucosal thickening involving the maxillary and ethmoid sinuses. Bone marrow signal and extracranial soft tissues are within normal limits.
1. Subcentimeter enhancing tissue within the left posterior aspect of the sella is compatible with residual adenoma while enhancing tissue within the right aspect of the sella likely representing at least predominantly normal pituitary gland tissue. Cystic lesion within the left anterior aspect of the sella may represent a cystic component of the adenoma versus unrelated Rathke cleft cyst. There is no change in appearance of the sella between 11/2014 and 11/2013, and comparison with prior studies would be helpful. No significant mass effect or suprasellar extension.2. Images of the brain demonstrate no evidence of infarct or intracranial mass effect.3. Mild chronic small vessel ischemic disease.4. Global parenchymal volume loss, which appears advanced for patient's stated age.