MRI BRAIN WITH AND WITHOUT CONTRAST:
CLINICAL HISTORY: 61-year-old male with right parietal mass.
FINDINGS:
BRAIN:
larger component overlying the right parietal occipital hemisphere and measuring approximately 4.9 x 3.9 x 4.2 cm. The smaller component overlying the left occipital lobe measures 3.6 x 2.3 x 3.7 cm. The mass has a
few cystic components.
Multiple flow-voids are seen within the mass with
increased perfusion on ASL and bolus images. There is
significant surrounding edema most notably in the right occipital and parietal lobes. Again seen is right to left midline shift of approximately 9 mm and right uncal and parahippocampal herniation, unchanged. There is no associated hemorrhage or
calcification. A 1 cm dural based enhancement seen mass is again seen
along the midline floor of the anterior cranial fossa. No acute infarct.
Ventricles and extra-axial spaces: Stable effacement of the right lateral ventricle and right ambient cistern. Asymmetric prominence of the left atrium may be due to early entrapment.
Orbits: Normal.
Visualized paranasal sinuses: Mild mucosal thickening in the maxillary and ethmoid sinuses which may be congestive or inflammatory.
Mastoid air cells: Clear.
Bones: Normal.
Additional comment: None.
INTRACRANIAL ANGIOGRAM:
Anterior circulation: No flow-limiting stenosis or aneurysm. The left A1 segment is hypoplastic.
Posterior circulation: No flow-limiting stenosis or aneurysm. Medial displacement of the right P3 segment from parahippocampal herniation.
Dural venous sinuses: Patent.
Additional comment: None.
PERFUSION:
Increased perfusion to the bilobed extra-axial mass overlying the parieto-occipital lobes.
IMPRESSION:
1. Bilobed dural based extra axial hypercellular, avidly enhancing mass arising from the posterior falx and tentorium. There is
significant surrounding edema with stable right-to-left midline shift, right lateral ventricular effacement, and right uncal and
parahippocampal herniation. This appearance is most concerning for a meningioma, with hemangiopericytoma or dural based metastasis considered less likely.
2. 1 cm dural based enhancing mass on the midline floor of the anterior cranial fossa concerning for meningioma, or less likely dural based metastasis.