74 years, Male, with meningioma, evaluate for change in size. There is a homogeneously enhancing extra-axial mass in the left paraclinoid region extending into the middle cranial fossa measuring 3.5 x 3.3 x 3.5 cm consistent with meningioma. Medially mass extends into the cavernous sinus with partial encasement of the left cavernous internal carotid artery. Mass also noted to abut the left V2 and V3 divisions of the trigeminal nerve. No significant luminal narrowing of the internal carotid flow-void is appreciated. Superiorly mass abuts the left M1 segment. No parenchymal edema is appreciated associated with the meningioma. There is local mass effect on the adjacent left anterior and medial temporal lobe. Comparison with available outside MRI from 4/19/2010 demonstrates the enhancing mass to measure 2.9 x 2.9 x 3.1 cm indicating interval enlargement.There are subcentimeter foci of susceptibility including the left anterior frontal lobe, right parietal lobe, as well as in the left parietal lobe abutting the splenium, which are compatible with chronic microhemorrhages. There is apparent susceptibility along the right caudate head which may be related to mineralization. Remainder of the brain parenchyma demonstrates mild global parenchymal volume loss as well as mild scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter compatible with mild small vessel ischemic changes. No midline shift or herniation. No hydrocephalus. There is diffuse opacification of the right maxillary sinus. There is an 18 mm enhancing calvarial lesion in the right lateral parietal calvarium with apparent vascular continuity superiorly and inferiorly and favored to represent a venous lake. Calvarium and extracranial soft tissues are otherwise unremarkable.
1. Compared to outside MRI dated 4/19/2010, there is mild interval enlargement of meningioma in the left paraclinoid region and middle cranial fossa.2. Foci of susceptibility compatible with chronic microhemorrhages in the left frontal and bilateral parietal lobes, possibly related to amyloid angiopathy but nonspecific. These are not appreciated on the outside 2010 MRI study, which was performed with a less sensitive technique.