 Somewhat motion limited exam. Limited sequences were obtained for stereotactic localization purposes with fiducials noted on the scalp. Redemonstrated are numerous intra-axial enhancing masses, with the largest in the left paramedian frontal parietal region measuring 2.3 x 2.6 cm, not significantly changed in size. There is heterogeneous signal again noted on T2-weighted images, with slight increased conspicuity likely relating to evolution of blood product compared to the prior exam. Previously, the superior right frontal lobe mass did not demonstrate significant susceptibility, with now evidence of prominent T2 hypointensity suggestive of new blood products. There is also associated mild localized mass effect with sulcal effacement in these areas without significant interval change. Redemonstrated is a heterogeneous peripherally solid and centrally cystic appearing mass in the expanded sella with suprasellar extension, which measures 1.8 x 2.0 cm. The blood-fluid level is slightly more pronounced and more symmetrically layered compared to the MRI from three days ago. The mass effect upon the overlying optic chiasm and gross partial encasement of the cavernous carotids without narrowing appears similar to the prior MRI exam.There is unchanged prominence of the ventricles and sulci, consistent with mild-moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are stable scattered punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. No extra-axial fluid collection is identified.
1.Multiple enhancing intra-axial masses with localized mass effect and vasogenic edema. There has been at least some evolution of the blood product in many of the masses, with interval development of blood products in the superior right frontal mass. This remains concerning primarily for metastatic disease.2.Redemonstration of an expansile partially solid and cystic versus necrotic mass centered in the expanded sella with significant suprasellar extension and mass effect upon the chiasm. Slight increased extent and symmetry of blood-fluid level within this mass which could indicate minimal additional hemorrhage. The differential includes a pituitary mass such as a macroadenoma, craniopharyngioma or superimposed metastatic disease. 