69-year-old female with large pituitary seen on head CT, essential tremor. BRAIN: There is no evidence of intracranial hemorrhage or acute infarct. Scattered punctate T2 hyperintensities in the periventricular and subcortical white matter are nonspecific, but suggest chronic small vessel ischemic disease. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.PITUITARY: Evaluation limited due to lack of IV contrast. There is an approximately 12 x 12 x 13 mm T1 isointense, slightly T2 heterogeneous mass within the sella and slightly eccentric to the left. Lack of IV contrast makes it nearly impossible to differentiate the mass from the surrounding pituitary gland; however, the pituitary stalk can be seen displaced posteriorly. The sella appears enlarged. There is no mass effect on the optic chiasm.
1. Within the limits of a noncontrast enhanced MRI, there is a mass in the sella without discrete visualization of the pituitary gland itself. Specifically this lesion most likely represents a pituitary macroadenoma. A non-pituitary mass lesion is conceivable but less likely.2. Scattered punctate T2 hyperintense foci in the periventricular and subcortical white matter are nonspecific, but suggest chronic small vessel ischemic disease.