 Post contrast images are slightly limited by patient motion. There is a prominent left frontal extra-axial mass which is T1 isointense to brain parenchyma and T2 hypointense, with associated scattered susceptibility. There is calvarial remodeling noted along the left frontal calvarium in this location, although without significant asymmetric hyperostosis. There is significant underlying left frontal lobe parenchymal T2/FLAIR hyperintensity as well as mild to moderate localized mass effect on the periphery of the left frontal lobe. The heterogeneously enhancing mass measures 2.2 x 2.9 cm in greatest axial dimensions on 14/131, x 2.8 cm oblique CC 1401/88. There is adjacent dural thickening and enhancement suggesting a dural tail. There is subtle blunting of the anterior body of the left lateral ventricle due to the minimal mass effect from vasogenic edema, as well as left frontal sulcal effacement.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes. There is a nonspecific punctate focus of susceptibility in the central pons which may relate to chronic hemosiderin deposition or mineralization. There is no pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. There are a few questioned areas of subtle focal prominence along the distal cavernous left internal carotid artery for example on 1100/120 and 1101/117, which appear somewhat triangular shaped and may represent tiny infundibulum. The midline structures and craniocervical junction are within normal limits. There is also incidental hyperostosis frontalis interna.
1. Heterogeneously enhancing left frontal extra-axial mass with localized mass effect and underlying prominent left frontal lobe vasogenic edema with minimal deformity of the anterior body of the left lateral ventricle. Associated enhancing dural tail suggests that this mostly likely represents a meningioma, with osseous remodeling. Differential diagnosis would include a dural metastasis.2. Mild-moderate chronic small vessel ischemic changes.