Clinical question: Assess for cyst. Signs and symptoms: Headache. Pre-and post-enhanced brain MRI:Diffusion weighted images are severely obscured by the calvarial metallic hardware (shunt) artifact overlapping the right side of the study. Beyond the artifact diffusion weighted images are negative.Flair and T2 weighted images also demonstrate metallic hardware artifact from patient's shunt placement which obscures part of the right hemisphere.Examination demonstrates mild enlargement of the supratentorial ventricular system with suggestion of mild interval increased size since prior head CT exam from 12 -- 9 -- 14. The transverse diameter of the third ventricle anteriorly measures of 11.2-mm compared to prior head CT examination of 8.3-mm. Combined ligaments of the frontal horns and lateral ventricles measures at 26.5-mm compared to prior CT examination measurement of 23 mm. The temporal horns of lateral ventricles also demonstrate minimal interval increased size.A right frontal approach ventricular catheter enters the right lateral ventricle and with the tip abutting the septum pellucidum in the right frontal horn lateral ventricle similar to prior exam. The cortical sulci remain patent and CSF cisterns are unremarkable.The morphology and signal intensity of brain parenchyma is otherwise within normal on all MRI sequences. There is no detectable cyst as is questioned clinically. This signal void in the major intracranial arterial branches are identified.There is no detectable abnormal parenchymal or meningeal enhancement. On reformatted post enhanced images there is a 3.3 mm focus of hypoattenuation in the inferior midline and left paramedian pituitary gland highly suspected for a microadenoma. There is no evidence of increased size of pituitary gland, normal position and enhancement of the pituitary stalk and unremarkable adjacent cavernous sinuses.The signal intensity of intracranial venous sinuses are within normal and with normal pattern of enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.All paranasal sinuses, mastoid air cells and bilateral middle ear cavities demonstrate normal pneumatization signal pattern.
1.Diffusion-weighted images are significantly obscured on the right secondary to metallic artifact and negative otherwise.2.Mildly prominent supratentorial ventricular system which measure minimally larger than prior head CT exam from 12 -- 9 -- 2014.3.Stable right frontal approach ventricular catheter with the tip in the right frontal horn of lateral ventricle.4.3.3-mm focus of hypo-enhancement in the inferior left paramedian pituitary representing a microadenoma.5.Unremarkable pre-and post enhanced brain MRI otherwise.