85 years, Male, metastatic lymphoma and recent blurry vision. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. There are extensive patchy areas of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic and/or posttreatment-related changes. There are two small foci of susceptibility in the right temporal lobe consistent with chronic microhemorrhages. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. Major flow-voids are preserved.Orbits are grossly normal. There is a round lesion involving the left aspect of the sella measuring approximately 7 x 5 mm in the transverse and craniocaudal dimensions with T1 hyperintensity and containing a fluid-fluid level. No suprasellar extension or mass effect on the optic chiasm. There is mild opacification of the ethmoid air cells. Bone marrow signal and extracranial soft tissues are within normal limits.
1. No evidence of metastatic disease in the brain. 2. No obvious mass is seen within the orbits. Dedicated orbital MRI can be considered if there is high suspicion for a structural lesion involving the orbits.3. Extensive patchy areas of signal abnormality in the white matter which is nonspecific and may represent chronic small vessel ischemic disease and/or posttreatment-related changes. There are two punctate foci of chronic microhemorrhage in the right temporal lobe, which are nonspecific in etiology.4. Subcentimeter cystic lesion involving the left aspect of the sella with fluid-fluid level. No suprasellar extension or evidence of mass effect on the optic chiasm. Finding may represent a cystic microadenoma with fluid/blood products; less likely Rathke's cyst given off midline location. 