Female, 75 years old, with left sixth nerve palsy and known cavernous sinus mass. Additional patient history includes multiple myeloma. There is a 3.1 x 2 7 x 2.5 cm well-defined, homogeneously enhancing lobulated mass with intermediate T1 and T2 signal centered on the left petroclival ligament. The lesion extends into the sella, left cavernous sinus and Meckel's cave, left middle cranial fossa and left prepontine cistern. A normal pituitary gland is not identified separately, though the pituitary stalk deviates slightly to the right as it enters this mass . There is enlargement of the sella turcica with infiltrative changes to the left aspect of the tuberculum sella and anterior superior aspect of the clivus. The mass completely encases a majority of the cavernous segment and part of the distal petrous segment of the left internal carotid artery, which are mildly narrowed. There is mild mass effect on the left aspect of the pons. The left cranial nerve VI is not well seen at the level of the exiting right cranial nerve VI. The mass also likely impinges encases the cisternal trigeminal nerve. The fourth ventricle is patent. There is no evidence of mass effect on the optic chiasm or other cranial nerves. Mild mass effect is present in the medial aspect of the left inferior anterior temporal lobe. No additional enhancing lesions are identified. The internal auditory canal structures appear normal. No abnormal fluid signal is demonstrated in the middle ear cavities, mastoid air cells or external auditory canals. Generalized cerebral volume loss is noted in the visualized portion of the brain. There is no evidence of hydrocephalus. No diffusion restriction is evident in the brain parenchyma.Asymmetric low T1 signal is noted in the region of the left parietal bone, best seen on coronal precontrast T1 imaging (series 12 image 29). Elsewhere, the marrow spaces peppered with numerous tiny abnormal foci of low signal.
1. Enhancing mass centered on the left petroclival ligament invading the skull base, left cavernous sinus and Meckel's cave, left middle cranial fossa, and left prepontine cistern. The location and imaging characteristics are fairly typical of a meningioma. Given the patient's history, the possibility of a myelomatous deposit or plasmacytoma would have to be considered as well. A pituitary macroadenoma would also be in the differential diagnosis, though this is probably less likely. 2. Replacement of fatty marrow in the left parietal bone is seen along with innumerable small foci of marrow signal abnormality. Findings would be compatible with patient's diagnosis of multiple myeloma. 