MRI - MRI Brain (9 months later)
Axial T1
Sagittal T1
Coronal T1
Axial T2
Axial T2
Axial SWI MIP
Axial SWI
Axial DWI
Axial ADC
Axial T1 C+
Coronal T1 C+
Sagittal T1 C+
14 x 14 x 17 mm (AP x ML x SI) extraaxial mass centred on the inferior aspect of the falx between the frontal lobes shows T1/T2 isointensity and diffuse contrast enhancement, spare a punctate focus inferiorly which may reflect calcification or flow void. Findings are consistent with a meningioma.
Small dural tail extending superiorly along the falx. The mass is slightly asymmetrical to the right but involves both sides of the falx. No adjacent cerebral oedema. The posterior aspect of the adjacent inferior sagittal sinus enhances normally with no evidence of direct invasion or thrombosis.
No other intra or extraaxial mass lesion nor abnormal areas of enhancement.
Evidence of previous right frontal craniotomy and small area of susceptibility in the right parietal subcutaneous tissues.
No hydrocephalus.
Note is also made of a 4cm fat containing subcutaneous mass in the right occipital region, incompletely imaged and containing a few thin internal septations - this presumably reflects a low grade fat containing tumour, however without pre and post contrast imaging of the entire lesion, a higher grade component cannot be excluded.
Conclusion:
17 mm frontal inferior falcine meningioma.