 Again seen is a large enhancing extra-axial mass along the planum sphenoidale in the midline which is T1 isointense to brain parenchyma and somewhat heterogeneous on T2-weighted images. There is evidence of minimal gradual enlargement, with the mass for example measuring 38 x 47 x 30 mm in the AP, transverse, and craniocaudal dimensions compared to 34 x 42 x 28 mm on prior post gadolinium study from 10/23/2013. There is significant interval increase in FLAIR hyperintensity in the subcortical right frontal lobe and to a lesser degree in the left frontal lobe. Local mass effect on the bilateral frontal horns is stable to minimally worse. Mass is again noted to abut the right prechiasmatic optic nerve.Again seen is background of bilateral periventricular and subcortical T2/FLAIR hyperintensity compatible with chronic small vessel ischemic disease and evidence of encephalomalacia in the left posterior frontal lobe likely related to prior infarct. There is global parenchymal volume loss commensurate with patient's advanced age. Prominence of the ventricular system is likely related to the volume loss. Prominent mineralization/iron deposition of the basal ganglia again noted. Foci of susceptibility again seen in the left frontal lobe peripherally, adjacent to the anterior body of the left lateral ventricle, and medial to the left atrium, likely representing chronic microhemorrhages. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures with some displacement of the A2 segments of the anterior cerebral arteries.
1. Minimal gradual enlargement of planum sphenoidale meningioma, which measures 38 x 47 x 30 mm in the AP, transverse, and craniocaudal dimensions compared to 34 x 42 x 28 mm on the prior post gadolinium study from 10/23/2013. There is also interval increase in the surrounding vasogenic edema in the frontal lobes.2. Moderate chronic small vessel ischemic disease and chronic left posterior frontal lobe infarct again seen.