67 years, Male, metastatic melanoma enrolling in immunotherapy trial. No abnormal parenchymal or meningeal enhancement. No restricted diffusion to suggest acute ischemia. A few small foci of susceptibility effect are demonstrated in the bilateral posterior frontal periventricular white matter, compatible with chronic microhemorrhages. A few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. There is a punctate focus of high T1 signal involving the choroid plexus of the left lateral ventricle with suggestion of hypoattenuation on prior PET/CT suggesting tiny lipoma. The ventricles are within normal limits in size and configuration. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. No evidence of intracranial metastatic disease. 2. Few nonspecific chronic microhemorrhages in the bilateral posterior frontal lobes.3. Mild chronic small vessel ischemic changes.