Reason: CNS lymphoma History: follow up and compare with previous MRI. The patient is status post transphenoidal hypophysectomy. There is marrow replacement present within the sphenoid bone which has been present since the patient's pituitary surgery and enhances following contrast administration. It has a heterogeneous appearance with cystic appearing components.A small focus of susceptibility effect is present in the right basal ganglia. This is likely related to prior hemorrhagic event.The patient is status post bur hole along the right frontal bone.There is redemonstration of a nodule in the right parotid gland which measures 13 x 13 mm axial dimensions and enhances following gadolinium administration. It is present on prior exams and may 3/24/2008 exam and measured 7 x 4 mm axial dimensions. On the 10/28/14 exam it measured 19 x 10 mm axial dimensions. It is associated with chemical shift artifact. It is of lower signal than the parotid gland on T2 imaging and on T1 imaging.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.No intraparenchymal mass lesions are appreciated to suggest CNS lymphoma.2.Heterogeneous appearance of the sphenoid bone and perisellar region status post transphenoidal hypophysectomy. This is suspected to represent postsurgical change and/or residual pituitary adenoma3.A nodule in the right parotid gland has been present and slowly growing over the past 7 years.4.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 