Benign neoplasm of cerebral meninges [D32.0] / Neoplasm of unspecified behavior of brain [D49.6], Reason for Study: h/o right frontal meningioma and also a pons lesions; please add spectroscopy. History: fatigue, weakness, elevated parathyroid hormone. There is 7.6mm x 11.3mm x 15.1mm extra-axial dural based enhancing lesion along the high right vertex at the level of the superior frontal sulcus. This lesion causes no significant mass effect upon the adjacent parenchyma and there is no evidence of parenchymal invasion or parenchymal edema. Allowing for differences in technique, no change is detected when compared to the prior examination.As on the prior examination, a 4 mm focus of somewhat ill-defined enhancement is evident within the right upper pons. On 3-D postcontrast images, there also appears to be a small linear vascular structure just below the area of enhancement. The lesion is associated with susceptibility effect, and a barely detectable punctate focus of FLAIR hyperintensity. No edema or mass effect is seen. No restricted diffusion is evident. Single voxel spectroscopy of this lesion shows no findings to suggest an aggressive or proliferative process. If anything, the level of choline at the lesion is reduced relative to an adjacent normal area of the pons.No additional enhancing lesions are seen. Brain parenchymal morphology and signal characteristics are otherwise unremarkable. No evidence of any parenchymal edema or mass effect is seen. No abnormal fluid collections are detected. The ventricular system is normal in size and morphology.
1.A small extra-axial mass compatible with meningioma is evident along the high right vertex at the level of the superior frontal sulcus. This lesion causes no significant mass effect upon or edema within the adjacent brain parenchyma.2.A small somewhat ill-defined focus of enhancement is evident within the right aspect of the upper pons with associated susceptibility effect and perhaps a small adjacent vascular structure. Spectroscopic findings do not suggest an aggressive or proliferative process. The imaging features and location of this lesion favor a benign vascular process such as a capillary telangiectasia. If clinical concern warrants, at least one follow-up examination can be considered to ensure stability.