Clinical question: Patient with elevated IgM-1 concerning for acromegaly. Need pituitary imaging. Signs and symptoms: As above. Pre- and post enhanced pituitary MRI:Examination demonstrates normal signal intensity, morphology and pattern of enhancement of the pituitary gland as well as pituitary stalk. Unremarkable suprasellar visual complex. Unremarkable cavernous sinuses. Unremarkable images to the skull base.Pre- and post enhanced brain MRI:Negative diffusion weighted images.FLAIR and T2-weighted images demonstrate multiple punctate and patchy foci of hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres and a few punctate foci in the pons. Findings are nonhemorrhagic and nonenhancing. Although nonspecific considering patient's stated age possibility of chronic small vessel ischemic strokes should be considered. The morphology and signal intensity of brain parenchyma is otherwise within normal MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces. There is no evidence of any abnormal enhancement of brain parenchyma, leptomeninges, calvarium or the orbits.Normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.
1.Unremarkable pre and post enhanced pituitary MRI.2.Pre- and post enhanced MRI of the brain demonstrate findings suggestive of mild to moderate chronic nonhemorrhagic small vessel ischemic strokes only in the subcortical - periventricular white matter and minimally of the pons and unremarkable exam otherwise.