Further assessment of a sellar mass. Pituitary MRI: The sella is expanded by a heterogeneous mass that measures up to 3.5 cm. The mass demonstrates predominantly peripheral enhancement and contains areas that are T1 and T2 hyperintense superiorly. The suprasellar component of the tumor exerts mass effect upon the optic chiasm. The tumor protrudes into cavernous sinuses, left greater than right. There is effacement of the sphenoid sinuses by the expanded sella.Brain MRI: There is no evidence of intracranial hemorrhage or acute infarct. There is mild diffuse cerebral volume loss. There are nonspecific scattered T2 hyperintense cerebral white matter foci that may reflect mild chronic microvascular ischemia. There is no midline shift or herniation. A small retention cyst is present in the left maxillary sinus. Mild ethmoid mucosal thickening is also nonspecific. There are bilateral lens implants.Brain MRA: The sellar and suprasellar mass abuts the cavernous internal carotid arteries, with partial encasement on the left side. The mass also abuts and mildly displaces the A2 segments of the anterior cerebral arteries. There is no evidence of significant steno-occlusive lesions. There is a prominent ACOM complex that measures up to 2 mm in width. Otherwise, there is no evidence of saccular cerebral aneurysms.
1. The sellar and suprasellar mass may represent a craniopharyngioma versus a pituitary adenoma with cystic change and hemorrhage.2. The sellar and suprasellar mass abuts the cavernous internal carotid arteries, with partial encasement on the left side, but no evidence of significant stenosis. 3. A prominent ACOM complex that measures up to 2 mm in width likely represents dysplasia rather than a true saccular aneurysm. Nevertheless, this may be follow via CTA or MRA to ensure stability. 