Neuro_MR_Brain: 61 M, thunderclap headache, bilobed dural based mass.

CLINICAL HISTORY: 61-year-old male with right parietal mass.

Parenchyma: Again seen is a bilobed hypercellular enhancing extra-axial mass involving the posterior falx and tentorium with 
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 componentsMultiple 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.
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.

Increased perfusion to the bilobed extra-axial mass overlying the parieto-occipital lobes.
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.

(Hemangiopericytoma/Solitary Fibrous tumor of the dura)

Accession: CL27388630

Study description: MR BRAIN WandWO CONTRAST