 There is a right-sided pituitary mass which measures 16 mm transverse by 10 mm craniocaudal by 11 mm AP dimension. It enters the adjacent cavernous sinus, abutting the cavernous carotid, however without arterial encircling or narrowing. There is no significant deviation of the pituitary stalk, and the mass does not approach the optic apparatus.A small T2 hyperintense multiloculated lesion is noted within the right paramedian clivus (best seen series 901 image 12/44) with a pedunculated portion which extends into the adjacent subarachnoid space abutting the basilar artery, however without arterial deformation or displacement. There is minimal, questionable enhancement along its lateral aspect. It demonstrates a narrow zone of transition with what appears to be intact cortical borders.There are scattered foci of T2 hyperintensity in periventricular and subcortical white matter (primarily subcortical) not associated restricted diffusion, mass effect, susceptibility abnormality, or enhancement. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. There is no abnormal enhancement within the brain.
1.Right sided pituitary macroadenoma which does not approach the optic apparatus.2.Clival-based lesion with an MRI appearance most consistent with ecchordosis physaliphora. Given the lack of significant enhancement, clival chordoma is felt to be less likely.3.Chronic small vessel ischemic disease.