 There is asymmetric enhancement along the left trigeminal nerve in the cisternal portion which extends as a heterogeneously enhancing mass centered in the left Meckel's cave/inferolateral left cavernous sinus measuring 14 x 7 mm on series 20 image 69 with further extension and enhancement along the left foramen ovale (series 22 image 22). There is asymmetric enhancement of the left V2 division of the trigeminal nerve from the Meckel's cave as it courses through the inferior orbital fissure and extends into the left infraorbital foramen.There is a 17 x 9 mm extra-axial dural based mass in the right parietal high convexity without significant internal enhancement (series 19 image 11, series 20 image 178), as well as a similar left high parietal convexity extra-axial dural based mass measuring 15 x 6 mm on series 19 image 19, series 20 image 187. There is no significant surrounding mass effect on the adjacent cortex or vasogenic edema.There is diffuse pachymeningeal enhancement which is smooth and may be reactive to the dural metastases elsewhere.There is no suspicious intra-axial enhancement. There is no acute infarct, mass effect or midline shift. There are scattered T2 signal abnormalities in the periventricular right frontal white matter which are nonspecific. There is no hydrocephalus.There is heterogeneous diffuse low osseous marrow signal and scattered enhancing lesions with restricted diffusion consistent with metastatic disease. There is a retention cyst in the right maxillary sinus.
1.Findings suspicious for multiple dural-based metastases. There is a heterogeneously enhancing extra-axial mass centered in the left Meckel's cave and inferolateral aspect of the cavernous sinus measuring 14 x 7 mm . Posteriorly mass contacts the cisternal segment of the left trigeminal nerve and anteriorly extends into the left foramen ovale. Asymmetric increased enhancement of the left V2 and V3 nerves is noted. These findings are compatible with patient's left CN V dysfunction. 2.Additional extra-axial masses along the bilateral parietal high convexities. No significant associated mass effect or vasogenic edema. 3.Diffuse osseous metastases.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.