71 years, Male, possible pituitary lesion seen with increased uptake on PET/CT, additional increased uptake seen in the region of right foraminal lacerum. Metastatic head and neck cancer.. Brain: There is extensive patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which is nonspecific but compatible with chronic small vessel ischemic disease. No findings to suggest acute infarct. There is a apparent focus of diffusion restriction in the left parietal lobe which corresponds to focus of susceptibility indicating chronic microhemorrhage. There are multiple additional foci of susceptibility effect indicating chronic microhemorrhage in the brain, predominantly in the lobar distribution, and may relate to amyloid angiopathy. No evidence of intracranial mass effect, midline shift, or herniation. Ventricles and sulci are within normal limits for age. Sella is grossly unremarkable without evidence of a suspicious mass or macroadenoma. Note a microadenoma can better evaluated with a dedicated pituitary MRI. No appreciable lesion is seen at the skull base including the foraminal lacerum.Neck: There is minimal asymmetric increased T2 hyperintensity and enhancement at the right tongue base which is nonspecific. No discrete measurable mass is appreciated.There is a right level 2B nodal mass measuring approximately 20 x 21 x 23 mm as seen on prior CT and is consistent with nodal metastasis. Otherwise no significant cervical lymphadenopathy or additional neck mass is appreciated.Degenerative changes are seen in the cervical spine including reversal of cervical lordosis and C4-C5 anterolisthesis. No high-grade spinal canal stenosis at any level. No suspicious osseous lesions.
1.No suspicious mass in the sella or lesion at the foraminal lacerum. Note a microadenoma can be better excluded with a dedicated pituitary MRI, if clinically indicated.2. Chronic small vessel ischemic disease. Multiple foci of chronic microhemorrhage which are nonspecific but given the distribution, the may be related to amyloid angiopathy. 3. Known right level 2 nodal metastasis is again seen. 4. No discrete measurable primary tumor is definitively appreciated. Mild asymmetric fullness and increased enhancement at the right tongue base which is nonspecific and can be correlated with pathologic findings.