Headache. Hemorrhagic sellar lesion on previous MRI. BRAIN:There is nodular heterotopia along the frontal horn of the right lateral ventricle, best seen on the coronal T2 sequence. The remainder of the brain shows normal signal and morphology. There is no acute infarct or brain hemorrhage. There is no midline shift or brain herniation. The ventricles and other CSF-containing spaces are normal in size. There is trace mucosal thickening in the paranasal sinuses. The orbits are unremarkable. The major intracranial vascular flow voids are preserved. There is no gross skull or scalp abnormality.PITUITARY:The well-circumscribed, homogeneously intensely T1/T2 hyperintense lesion involving the pituitary gland has increased in size. In height, it measures 8 mm compared to 4 mm previously and extends slightly into the suprasellar cistern but still separate from the optic chiasm. There is a thin rim of pituitary tissue which normally contrast enhances surrounding this lesion. There is suggestion of a layering fluid level with susceptibility, axial image 482 series 901 although artifact from the bony sella and sphenoid sinus limit assessment of this region. The normal posterior pituitary T1 hyperintensity is preserved. The pituitary infundibulum is midline and there is no hypothalamic abnormality. The sella turcica is not expanded and the cavernous sinuses are unremarkable.
Homogeneous, well-circumscribed, intensely T1/T2 hyperintense lesion within the anterior pituitary has increased in size since August 2015. There appears to be layering of debris or blood products. Rathke's cleft cyst is favored. Cystic microadenoma with layering fluid or hemorrhage or small craniopharyngioma are possible but seem less likely given the well-circumscribed, homogenous nature of the lesion and the lack of perceptible contrast enhancement except in the displaced pituitary tissue. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.