Weakness. Correlating with the homogeneously hyperattenuating mass on CT, there is a mildly T1-hypointense, T2-hyperintense, relative to gray matter, mass in the periventricular/deep left frontal white-matter involving the left centrum semiovale as well as the body of the corpus callosum, which measures transaxially 2.6 cm x 2.2 cm and craniocaudally 1.9 cm. It shows solid but mildly heterogeneous pattern of contrast enhancement and has diffusion characteristics that are similar to gray matter. It causes mild mass-effect on the adjacent structures, including the roof of the left lateral ventricle. Accounting for the fairly symmetric bifrontal periventricular hypoattenuation, which may reflect microvascular ischemia, there is no definite perilesional hypoattenuation/edema.Another lesion with similar signal characteristics but only minimal, vascular pattern of vascular contrast enhancement is present in the region of the posterior limb of the right internal capsule which has superior extension along the corona radiata. This is not associated with perilesional edema. A third lesion with similar signal characteristics but without perceivable contrast enhancement is present in the splenium of the corpus callosum. This is associated with minimal associated perilesional edema.There is no midline shift or brain herniation. Similar to the above-described confluent periventricular bifrontal white-matter T2-hyperintensity, there is confluent biparietal white-matter T2-hyperintensity. There are also multiple punctate T2-hyperintense lesions in the cerebral white-matter. These findings likely reflect incidental chronic microvascular ischemia. The ventricles and the other CSF-containing spaces are mildly expanded, reflecting global mild brain volume loss. There is also a cavum septum vergae/cyst with mild mass-effect on the internal cerebral veins, which is incidental.There is mucosal thickening in the maxillary and ethmoid sinuses. There is also a left maxillary retention cyst. The orbits are notable for bilateral lens replacement. There is no destructive skull lesion.
1.Multifocal periventricular and deep cerebral white-matter lesions show signal characteristics that are suggestive of dense cellularity or high nucleus-to-cytoplasmic ratio. One shows solid contrast enhancement while the other shows minimal vascular to no contrast enhancement. The mass-effect is relatively mild to the size of the lesions and there is no or minimal associated peripheral lesional edema as described above. The imaging characteristics are most suggestive of CNS involvement by lymphoma. The homogeneity of the lesions and the lack of perilesional edema or significant mass-effect would make primary brain tumor, metastasis and inflammatory/infectious etiologies much less likely.2.Otherwise, there are relatively mild changes of chronic microvascular ischemia and global brain volume loss. Incidental cavum septum vergae/cyst with mild mass-effect on the internal cerebral veins.