Please obtain high res (1mm thickness) MRI T1-weighted to further characterize lesions. Differential: myeloma vs other neoplasm, inflammation, infection. History: left inferior nasal field vision blurring, 4y h/o myeloma, pt got MRI at OSH (uploaded in system) showing enhancing lesions in Lt optic n., left frontal leptomeninges, and 2 nodules in left cerebellum. There is no evidence of intracranial hemorrhage, large mass, or acute infarct. There is decreased subcortical T2 hyperintensity in the left frontal lobe. The cerebellum appears to be grossly unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There is mild thickening diffusely along the left optic nerve sheath.
No evidence of intracranial hemorrhage, large mass, or acute infarct. However, characterization of the previously demonstrated lesions is limited due to the lack of contrast. Likewise, the left optic nerve sheath abnormality is not well-characterized without intravenous contrast. Otherwise, there is decreased nonspecific subcortical T2 hyperintensity in the left frontal lobe. 