52 years, Male, chronic headaches. Brain MRI: No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Patchy areas and scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild to moderate chronic small vessel ischemic changes. There is mild global parenchymal volume loss. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Sella and orbits are grossly within normal limits. There is moderate degree of mucosal thickening involving the right maxillary sinus and to a slightly lesser degree the left maxillary sinus. There is also moderate right frontal sinus opacification. Mild mucosal thickening is also evident in the left frontal sinus, anterior and posterior ethmoid air cells, and the sphenoid sinuses. There is a nonspecific 1 cm lesion involving the left aspect of the clivus. No associated osseous destruction. Bone marrow signal and calvarium are otherwise unremarkable.Brain MRA: The intracranial internal carotid arteries demonstrate no significant stenosis. The middle and anterior cerebral arteries are also patent. The vertebral arteries, basilar artery, and posterior cerebral arteries also are patent with no significant stenosis. No evidence of aneurysms or vascular malformations. Right vertebral artery is dominant. Anterior communicating artery and left posterior communicating artery are not definitively seen which can be normal variant.
1. No intracranial mass or mass effect. There are mild to moderate chronic small vessel ischemic changes and mild parenchymal volume loss. Brain parenchyma appears otherwise unremarkable.2. Pansinus disease, which may be contributing to patient's headaches.3. MRA head is unremarkable with no aneurysms or significant stenosis.4. There is a 1 cm enhancing osseous lesion involving the left aspect of the clivus which is nonspecific. No osseous destruction or soft tissue component. Would suggest comparison with prior CT or MRI if available. Alternatively, follow-up should be considered to confirm stability.