67 years, Female, headache after age 40, nausea. There is a 7 x 8 mm enhancing lesion along the surface of the left inferior frontal lobe, which is favored to be extra-axial in location and demonstrates a broad base compatible with meningioma. No associated edema or mass effect. There is confluent as well as scattered foci of T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter which are nonspecific but compatible with moderate chronic small vessel ischemic disease. No evidence of acute infarct or hemorrhage. There is prominence of the perivascular spaces in the basal ganglia. T2/FLAIR hyperintensity involving the pons is also nonspecific but compatible with small vessel ischemic disease. No hydrocephalus. No extra-axial collections. There is a nonenhancing 5 x 6 mm T1 hyperintense and T2 hypointense lesion involving the posterior aspect of the pituitary gland which may represent a Rathke's cleft cyst. No suprasellar extension or evidence of mass effect.There is opacification involving the lateral recess of the left sphenoid sinus. There is also mild mucosal thickening involving the inferior aspect of the bilateral maxillary sinuses. Calvarium and remainder of the extra cranial soft tissues are unremarkable.
1. 7 x 8 mm enhancing lesion along the surface of the left inferior frontal lobe likely represents a small meningioma. Would suggest comparison with prior studies if available or short-term follow-up to exclude more aggressive etiologies. No associated edema. No other enhancing lesions within the brain or evidence of intracranial mass effect.2. Subcentimeter nonenhancing lesion involving the posterior aspect of the sella can be better assessed with a dedicated pituitary MRI study but may represent a Rathke's cleft cyst. No associated mass effect.3. Multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as in the pons are nonspecific but compatible with moderate chronic small vessel ischemic disease.