 BRAIN: There are numerous (greater than 15) supratentorial and infratentorial T2 hyperintense periventricular and subcortical oval as well as punctate white matter lesions predominantly showing high DWI signal without corresponding low ADC signal. However, a few lesions demonstrate a partial peripheral rim of subtle diffusion restriction, located in the right centrum semiovale and medial right periatrial white matter. Overall, there has been interval improvement with decrease in size of multiple lesions including the left brachium pontis lesion, confluent T2 hyperintense lesion in the right centrum semiovale, left frontal lobe subcortical white matter lesion adjacent to the left frontal horn. A large right medullary lesion is also again identified. There is slight increased size of the lesion in the right posterior temporal lobe deep white matter on 601/15 and 701/18 and also involving the diffusion restricting right periatrial lesion.Most of the lesions do not enhance except a lesion adjacent to the atrium of the right lateral ventricle on series 2901 image 15 which did not show enhancement previously, and a lesion in the right centrum semiovale on series 2901 image 21 which showed enhancement previously, correlating with areas of mild diffusion restriction noted above. On delayed post contrast orbital images, there is also suggestion of faint enhancement associated with a right frontal deep white matter lesion as seen on 3401/33.There is no acute infarct. The ventricles and basal cisterns are prominent, consistent with mild global volume loss slightly greater than expected for patient's stated age. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. ORBITS: The globes and extraocular muscles are intact with normal signal intensity and caliber. The lens are not dislocated. The optic sheaths and optic nerves are within normal limits in caliber and signal intensity without enhancement. There is no suspicious enhancement within the orbits. There is no proptosis. The pituitary gland is not enlarged. There is no mass effect on the optic chiasm. The pituitary stalk is midline. The cavernous sinuses are symmetric in enhance normally. There is no enlargement of the superior ophthalmic veins.CERVICAL: There is normal alignment, vertebral body and disk heights, as well as normal osseous marrow and cord signal. There is no suspicious enhancement in the cervical spine. There is no significant disk herniation or spinal stenosis at any level in the cervical spine. There is partial visualization of the focal right medullary demyelinating lesion.
1.Numerous supratentorial and infratentorial T2 hyperintense white matter lesions consistent with known underlying disease, many of which have decreased in size. Many of these lesions which were enhancing on the prior exam and no longer enhance with the exception of one right centrum semiovale lesion demonstrating persistent enhancement as described above. Associated incomplete diffusion restriction in this location as well as in the right periatrial lesion which demonstrates new enhancement, with additional incompletely evaluated right sided corona radiata enhancing lesion only seen on delayed post contrast orbital images. Slight increased extent of abnormal signal associated a few right-sided supratentorial lesions. Overall, minimal T1 and mild-moderate T2 burden of disease.2.No signal abnormality or enhancement in the optic apparatus or cervical cord to suggest involvement by demyelinating disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.