 Redemonstrated is a small collection of T2 hyperintense foci within the left frontal white matter (best seen FLAIR technique series 801 image 8/25). This is not associated with susceptibility abnormality or enhancement. It correlates with an adjacent collection of perivascular spaces (best seen series 70 on image 15/30) both laterally in a subcortical location as well as in a perivascular/periventricular location. The larger more anterior focus of this collection is associated with a demonstrable parallel vessel as demonstrated by susceptibility weighted imaging (series 90 on image 36/120).The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Scattered, sporadic, minimal foci of mucosal thickening can be found of the paranasal sinuses. A small focus of inflammatory change is noted in the medial left mastoid air cells. The right mastoid air cells are clear. There is no abnormal enhancement within the brain.
1.Redemonstrated is a small collection of T2 hyperintense foci within the left frontal white matter (best seen FLAIR technique). This is not associated with susceptibility abnormality or enhancement. It correlates with an adjacent collection of perivascular spaces both laterally in a subcortical location as well as in a perivascular/periventricular location. The larger more anterior focus of this collection is associated with a demonstrable parallel vessel as demonstrated by susceptibility weighted imaging. The constellation of these MRI imaging features is most suggestive of parenchymal T2 hyperintensity associated with perivascular spaces, which has been described in the literature. Other etiologies remain in the differential diagnosis, given this atypical perivascular appearance, however are considered to be less likely. Recommendations are made to perform repeat MRI imaging with contrast in one year at 3 Tesla to assess for stability (or consider sooner if patient symptomatology worsens). 3 Tesla imaging could also help to better define the associated anatomy.2.Scattered, sporadic, minimal foci of mucosal thickening can be found of the paranasal sinuses. A small focus of inflammatory change is noted in the medial left mastoid air cells. 