76-year-old male with a hypermetabolic sellar mass and metastatic thyroid cancer to the posterior aspect of T9. BRAIN/PITUITARY:No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. The expected location of the pituitary gland, there is a mass that measure 1.4 x 1.3 cm sagittally and 2.1 cm coronally that appears to have slightly expanded the sellar space and superiorly comes near but does not abut the optic apparatus. No apparent mass effect is seen on adjacent structures. A small portion of the mass enters the left cavernous sinus and abuts the cavernous carotid, however without narrowing. The pituitary stalk is displaced rightward. No calcifications are visualized. The lesion is isodense to brain matter on T1/T2 and demonstrates heterogeneous enhancement.Further, there is a small T2 hyperintense frontal lesion measuring 8 x 9 mm (series #28, image 16) that is nonenhancing. This likely represents a prominent perivascular space adjacent to an area of chronic small vessel ischemic disease.Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter without restricted diffusion, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Further, there is mild volume loss without a lobar predominant atrophy pattern.No abnormal meningeal enhancement. Major flow-voids are preserved.Orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. THORACIC/LUMBAR SPINE:There is redemonstration of the known thyroid metastasis centered posterior to the T9 vertebral body, though extending from T8 to T10. The lesion measures 45 x 39 mm in the sagittal plane (series #4, image 17). The mass appears centered between the left posterior elements of T8 and T9. The mass appears to invade the posterior elements of T8, T9, and T10 and vertebral bodies of T8 and T9. Anteriorly the mass severely narrows the spinal canal and the cord appears dysmorphic in appearance. Laterally, there is medial left rib invasion of T8, T9, and T10. The mass also abuts/infiltrates in the right medial T9 rib. There is obliteration of the T8-T9 and T9-T10 neuroforaminal spaces on the left.There is a separate lesion concerning for metastasis centered within the body of T10.Five lumbar type vertebral bodies are presumed to be present. Vertebral body heights are within normal limits. There is trace anterolisthesis of L4 on L5 trace retrolisthesis of L5 on S1. There is multilevel facet disease worse at L4-L5 and L5-S1. Bone marrow signal is benign. The conus medullaris is normal in position at the L1-L2 level.The right thyroid mass is redemonstrated. Further, there is a moderate left pleural effusion. There is extensive fatty deposition within the paraspinal and retroperitoneal spaces.
1. 1.4 x 1.3 sellar mass without abutment of the (distal likely represents a macroadenoma, or less likely a metastasis.2. Redemonstration of known thyroid metastasis posterior to the T9 vertebral body with invasion as above.3. A separate lesion concerning for metastasis is centered in the T10 vertebral body.4. There is a left pleural effusion.