78-year-old female with hx of CVA, DMII, HTN with dysequilibrium, tinnitus, hand numbness, evaluate for mass, stroke, other. There is no restricted diffusion on DWI sequences.There is a well-demarcated dural based extra-axial mass. Medially along the floor of the anterior cranial fossa on the right side measuring 16 mm in craniocaudal dimension (series 601, image 9) and 27 mm x 13 mm on axial sequences (series 1101, image 13). The lesion demonstrates low T1 intensity and increased T2 and FLAIR signal intensity with uniform marked enhancement. There is uniform subtle susceptibility artifact. The lesion demonstrates minimal if any mass effect and does not extend through the skull base with no associated destruction of the bony structures. There is no associated intraparenchymal edema adjacent to the mass. There are no additional abnormal areas of enhancement or mass lesions identified.There is minimal scattered periventricular and subcortical T2/FLAIR hyperintense foci compatible with small vessel white matter disease.The visualized paranasal sinuses are clear. The mastoid air cells are well pneumatized. The visualized orbits are unremarkable.The CSF spaces and ventricles are within normal limits for patient's age.
1. Well demarcated right-sided dural based extra-axial mass along the floor of the anterior cranial fossa as described above. The imaging characteristics favor a meningioma, however other differentials for a lesion in this location include in an esthesioneuroblastoma as well as a hemangiopericytoma. There is no associated extension through the skulls base, destruction of the osseous structures or intraparenchymal edema to suggest an esthesioneuroblastoma. Recommend CT to further characterize the mass including possible calcification which would also favor a meningioma. 2. Minimal small vessel white matter disease as described above. 