39-year-old female with history of paresthesias. Evaluate for structural lesions. Brain: There are no areas of restricted diffusion to suggest an acute ischemic infarction. There is no evidence of acute intracranial hemorrhage. There are minimal curvilinear and punctate foci of increased T2/FLAIR signal within the frontal and parietal periventricular and subcortical white matter bilaterally. The corpus collosum appears spared. The ventricles and sulci are symmetric. The basal cisterns are intact. The visualized paranasal sinuses and mastoid air cells are clear. Flow voids are appreciated in the major intracranial vessels.Lumbar spine: The lumbar spine is in normal alignment, with a normal lumbar lordosis. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the L1 level. THere is mild facet arthropathy at L4-5 and L5-S1. There is no significant disc bulge, herniation, spinal canal or foraminal stenosis within the lumbar spine.There is a partially imaged large fluid filled structure only seen on axial series within the anterior aspect of the pelvis which likely represents a distended bladder. Additionally, there is a large T2 hypointense structure with adjacent septated cystic structure only partially imaged on sagittal series. These findings may represent normal structures, although dedicated imaging is recommended for confirmation and to exclude any pathologic process.
1. Curvilinear and punctate foci of increased T2/FLAIR signal within the frontal and parietal periventricular and subcortical white matter bilaterally have the morphology of benign perivascular spaces, although signal abnormality persists on FLAIR imaging. Another diagnostic consideration is a demyelinating process such as multiple sclerosis, however this appearance is not classic and thus these findings are ultimately nonspecific.2. Mild facet arthropathy of the lower lumbar spine.3. Nonspecific and partially imaged findings in the pelvis as above for which dedicated pelvic imaging is recommended. Ultrasound would be an appropriate first choice for this imaging.