 Pituitary MRI:Dedicated images through the sella demonstrate stable post-surgical changes of a prior transsphenoidal resection, with normal enhancing pituitary tissue along the margins of the sella. However, there is still an asymmetric focus of soft tissue occupying the inferior aspect of the right cavernous sinus which causes mild elevation of the cavernous ICA, although this does not appear significantly changed in size and configuration compared to the exam from 2015. There has been some interval lobulated appearance of the enhancing soft tissue, with mild increased T2 signal hyperintensity in this region indicating a more cystic character which may be related to previous radiation treatment in 2013.Brain MRI:There is nonspecific diffuse mild, thin, and smooth pachymeningeal thickening which is stable since the MRI from 2015 but was not present in 2013. There is no sagging of the brain. There is a homogeneously enhancing plaque-like extra-axial mass along the right aspect of the falx in the posterior frontal region measuring 1.0 x 1.4 cm (series 15, image 140). There is no significant mass effect on the brain parenchyma. However, the flow void through the superior superior sagittal sinus in the area of mass is not well seen, which may indicate invasion by the mass. Within the left inferior frontal lobe is a incidentally noted developmental venous anomaly. There is a subtle small rounded nonspecific T2/FLAIR hyperintense focus within the left cerebellar white matter.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation,
1.Stable post-surgical findings of a prior transsphenoidal pituitary procedure with normal enhancement of the visualized pituitary gland.2.Stable asymmetric enhancing tissue occupying the inferior aspect of the right cavernous sinus with mild elevation of the right cavernous ICA, without significant change in size or configuration compared to the exam from 2015. Mild increased T2 signal hyperintensity in this region indicates a more cystic character which may be related to previous radiation treatment.3.Small right parafalcine plaque-like mass, likely represents a meningioma, and appears similar in size compared to the prior exam.4.There is poor visualization of the flow void through the superior sagittal sinus in the region of the presumed meningioma, raising the question of possible invasion of the sinus by the mass vs. narrowing from mass effect. This could be further evaluated with a MRV head.5.Nonspecific mild diffuse pachymeningeal thickening stable since 2015 but new since 2013. Findings are of uncertain etiology, and clinical correlation is recommended, especially for any history of recent CSF access.