Neoplasm of unspecified behavior of endocrine glands and other parts of nervous system [D49.7], Reason for Study: ^Reason: 3 T SCANNER WITH CSF FLOW PLEASE History: PINEAL TUMORAdditional history from EMR: pineal parenchymal tumor of intermediate differentiation Images are limited by patient motion. There is regeneration of postoperative changes from previous partial resection of a infiltrative appearing enhancing lobulated pineal tumor, with right paramedian occipital approach. There is underlying right occipital pole encephalomalacia. Compared to the recent exam from 11/4/2016, there has been no significant interval change in the overall morphology and size of this heterogeneously enhancing mass, again measuring up to 37 mm transverse. On T2-weighted images, there is again an infiltrative appearance involving the thalami bilaterally, with more cranial extension on the right side and associated mass effect upon the posterior aspect of the third ventricle. The tectum is not discretely delineated, engulfed by the mass. The cerebral aqueduct is not well visualized.A right frontal approach ventriculostomy catheter is again seen, with tip near the septum pellucidum at the level the body of the lateral ventricles. Although third ventricular dilatation appears similar in degree, lateral ventricles are increasingly dilated and rounded in morphology especially along the atria, with the right atrium now measuring 22 mm transverse compared to previous 18 mm. There appears to be stable thickness of periventricular abnormal T2 hyperintensity. Additional patchy areas of T2 hyperintensity are seen elsewhere throughout the cerebral white matter.CSF flow imaging appears technically limited. Biphasic flow is identified only along the ventral brainstem and upper cervical cord, as well as the dorsal upper cervical spinal canal. Biphasic flow is not identified through the aqueduct ventricle.A prominent oval area of mild T2 hyperintensity seen along the left occipital scalp is nonspecific, although previous imaging demonstrated avid enhancement. This measures approximately 17 x 18 mm in greatest axial dimensions. It does appear to involve the skin surface.
1. Stable appearance of lobulated heterogeneously enhancing pineal mass with infiltrative involvement of the thalami bilaterally, greater on the right side.2. Slight interval increased dilatation of the lateral ventricles with stable right frontal approach ventriculostomy catheter. CSF flow imaging is somewhat technically limited, although appears to demonstrate lack of flow through the cerebral aqueduct and fourth ventricle, with minimal flow detected along the ventral brainstem and ventral as well as dorsal upper cervical spinal canal.3. Redemonstration of oval mildly T2 hyperintense 18 mm lesion in the left occipital scalp with heterogeneous enhancement, extending to the skin surface. Please correlate with direct inspection, although the finding has been present since baseline exam of May 2014, potentially representing a sebaceous cyst with associated infectious or inflammatory changes..