Secondary malignant neoplasm of brain and spinal cord [198.3], Reason for Study: ^Reason: adenoid cystic carcinoma w/ L orbital involvement. History: Eval extent of tumor and change from prior imaging. Orbit MRIThere are T2 low to intermediate signal intensity and T1 low signal intensity with inhomogeneously enhancing mass at the left pterygopalatine fossa which ascends through the left inferior orbital fissure and the left temporal lobe. The enhancing mass encases left optic nerve and appears to be involving the anterior aspect of the left cavernous sinus.Prior scan obtained out side hospital is available but cannot be compared directly due to different technical parameters and motion artifacts, however, it appears to be grossly no significant interval change in terms of the extent of the disease.The right side globes, optic nerves, extraocular muscles and retroglobal spaces are symmetric and normal. The lacrimal glands are normal. Brain MRI There is evidence of intra axial mass with surrounding edema on the left temporal lobe with irregular margined enhancing mass which appears to be connected to the mass on the posterior aspect of orbit, anterior and lateral aspect of the left cavernous sinus. There is also enhancing lesion on the left side foramen ovale which is connected to the left middle cranial fossa.There is also acute/subacute ICH on the left frontal lobe with subtle mass effects.Underlying brain shows multiple scattered high signal intensities on FLAIR images indicating non specific small vessel disease.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no restricted diffusion/acute ischemia.The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Opacifications of the left ethmoid sinus, sphenoid sinus and frontal sinus were seen.
1. Extension of extracranial mass through the left inferior orbital fissure and left side foramen ovale toward posterior aspect of the left orbit, anterolateral aspect of the left cavernous sinus and left anteromesial temporal lobe. 2. Left frontal subacute/acute ICH.3. Non specific small vessel ischemic disease.