84-year-old male preop planning for resection of a left extra-axial mass. PMH of metastatic prostate cancer. Redemonstrated along the left frontal convexity is a large multilobulated heterogeneously enhancing extra-axial dural based mass with some mass effect on the adjacent brain parenchyma, some surrounding vasogenic edema and 3 mm of rightward midline shift. The mass measures approximately 2.3 x 2.5 cm. There is some adjacent meningeal thickening and enhancement as well as enhancement, thickening and replacement of the adjacent right frontal calvarial marrow indicating osseous involvement.There is no evidence of intracranial hemorrhage or acute infarct. There is additional scattered periventricular and subcortical white matter hypoattenuation which is nonspecific. The basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. A small right maxillary sinus mucous retention cyst or polyp is seen.
1.Multilobulated heterogeneously enhancing left frontal extra-axial mass with adjacent brain parenchymal mass effect, vasogenic edema, and 3 mm rightward midline shift. There is also left frontal meningeal thickening and enhancement as well as thickening, enhancement and replacement of the adjacent right frontal calvarial marrow suggesting osseous involvement. Given the patient's history of metastatic prostate cancer, these findings are suspicious for a metastatic lesion. An unusual meningioma is an alternative explanation.2.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 