Clinical question: Past pituitary adenoma. Evaluate for or regrowth of adenoma. Signs and symptoms: Worsening memory for a year. Pre-and post-enhanced pituitary MRI:Examination demonstrate stable post surgical changes of prior removal of pituitary adenoma. There is no convincing evidence of residual tumor which is a similar observation as prior study. There is revisualization of pituitary stalk with rightward course and termination to residual pituitary gland on the right similar to prior exam. Heart remarkable bilateral cavernous sinuses and similar to prior study. Unremarkable suprasellar visual complex.Pre-and post-enhanced brain MRI:Negative diffusion weighted images.T2 flair images demonstrate minimal punctate foci of hyperintensity in the periventricular white matter of cerebral hemispheres which are nonspecific however often represent microvascular ischemic changes. There are no prior dedicated brain MRI in particular of flair sequence which makes precise comparison difficult. However comparison with prior axial T2 weighted images demonstrate no convincing evidence of progression of findings.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and myelination are brain otherwise. Post-enhanced images fail to demonstrate any abnormal parenchymal, leptomeningeal, calvarial or orbital enhancement.The signal void of major intracranial arterial branches are identified. The signal intensity of the intracranial venous sinuses is within normal and with normal pattern of enhancement.
1.Stable post surgical changes of pituitary adenoma resection since prior exam and without evidence of residual tumor.2.Negative diffusion weighted images.3.Minute periventricular flair hyperintensity although nonspecific it could represent chronic microvascular ischemic changes of minimal degree.4.No detectable abnormal enhancement and unremarkable brain MRI otherwise.