Headache [R51] / Malignant neoplasm of prostate [C61], Reason for Study: ^Reason: Pt is 72 y/o male wtih met small cell prostate cancer now with new headaches and head pain, evaluate for met diseaes History: met small cell prostate cancer, headaches There is inhomogenous but mainly low attenuation on T1, slightly expansile, lesion with Gad enhancement at clivus. There is no definitive evidence of associated soft tissue mass. MR signal intensity of skull appears to be within normal limits. Differential diagnosis include metastatic lesion and fibrous dysplasia. Other differential diagnosis including chondrosarcoma and chordoma can be considered but less likely based on above findings. No evidence of acute ischemic or hemorrhagic lesion.No evidence of abnormal enhancement.The ventricles, sulci and cisterns are symmetric and unremarkable. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Mucosal thickenings on bilateral ethmoid sinuses.Normal low signal intensity of right eye lens is not seen indicating post-surgery(cataract surgery most likely) status.
1. Slightly expansile clival lesion with enhancement as described above. Differential diagnosis include metastasis, fibrous dysplasia, chondrosarcoma and chordoma. For further imaging evaluation, sellar CT scan with covering clivus and/or bone scan can be considered.2. No evidence of acute ischemic or hemorrhagic lesion.