Encounter for examination for normal comparison and control in clinical research program [Z00.6], Reason for Study: ^Reason: Metastatic esophageal cancer please assess for CNS involvement prior to starting therapy on a clinical trial There is no evidence of acute ischemic or hemorrhagic lesion.There is relatively well-circumscribed round homogeneous enhancing lesion on just lateral and superior aspect of the right anterior clinoid process (series 12, image 13). The lesion shows slightly low signal intensity on T2 without susceptibility artifacts. There is no surrounding edema. There is no MR evidence of flow void. There is no mass effect seen.This lesion is likely represent extra axial lesion such as a small meningioma. The chance of an aneurysm from supraclinoid segment ICA is less likely. Exophytic intra axial lesion including possible metastatic lesion is also less likely but cannot completely exclude the possibility. Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter and centrum semiovale indicate non specific small vessel ischemic disease.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Small retention cyst in the left maxillary sinus, left posterior ethmoid sinus and sphenoid sinus rule out occult.
1. No evidence acute ischemic or hemorrhagic lesion.2. A small nodular enhancing lesion on the superior posterior aspect of the right anterior clinoid process is seen. Diagnostic possibility is a small meningioma. Differential diagnosis include a small arterial aneurysm and exophytic nature metastatic nodule.Comment: To exclude possibility of arterial aneurysm, CTA of head can be considered. Regarding possible metastatic lesion, either a follow up MRI or thin sectioned brain MRI with and without contrast enhancement can be considered.