80 years, Male, altered mental status. History of prostate cancer. Evaluate for brain metastasis.. There is no intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement to suggest intraparenchymal or meningeal metastases. Several scattered foci and patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. A right occipital developmental venous anomaly is incidentally noted. There is global parenchymal volume loss, commensurate with patient's age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No extra-axial collections. Major flow-voids are preserved.There is a 7 x 11 x 10 mm heterogeneously enhancing lesion involving the posterior aspect of the sella. Lytic lesion seen involving the dorsum sella on recent CT from 10/25/2015.There is heterogeneity of the bone marrow signal including focal osseous lesions involving the left parietal and right occipital calvarium as well as the clivus, occipital condyles, and visualized upper cervical spine. There is mild mucosal thickening involving the paranasal sinuses, which are otherwise clear.
1. No intraparenchymal metastatic lesions are appreciated. No evidence of acute infarct, hemorrhage, or intracranial mass effect.2. There is a 7 x 11 x 10 mm enhancing lesion involving the posterior aspect of the sella abutting the pituitary gland suspicious for metastasis. There is an adjacent lytic osseous lesion involving the dorsum sella better seen on recent CT. 3. Multifocal additional osseous metastases involving the calvarium and visualized upper cervical spine. 4. Mild chronic small vessel ischemic changes.