Reason: evaluate for new vascular changes; Hb SS; CVAs; moyamoya; s/p EDAS 11/22/06 History: increasing headache frequency (twice weekly) all July 2015 (no headaches for several months before July) MRI brain:There is redemonstration of right parietal encephalomalacia within the right MCA/ACA watershed territory which appears similar to the prior exam. Additional scattered small foci of increased T2 signal within the left caudate and bilateral frontal lobes is minimally, if any, increased in the right posterior frontal lobe. Widening of the right cerebral hemispheric sulci is unchanged and reflects volume loss. The ventricles are unchanged in size and configuration. No evidence of an acute infarct. No mass effect, midline shift or basal cistern effacement. The major cerebral flow voids are grossly unchanged, however see below for further details. The orbits and scalp soft tissues are grossly unremarkable, including visualization of the area of the right lateral synangiosis. Diffusely low T1 marrow signal within the calvarium is unchanged and likely reflects chronic anemia.MRA brain:The right internal carotid artery is diminutive with absent flow related enhancement distally and reconstitution immediately proximal to the MCA origin, appearing similar to the prior exam. Minimal attenuation of the right distal MCA branches appear similar to the prior exam. The right A1 segment is better visualized than the prior exam appearing normal, which is likely due to differences in technique.The left A1 is not well visualized and A2 is diminutive, similar to the prior exam. Mild narrowing of the left ICA at the terminus appears less prominent than the prior exam which is likely due to differences in technique. Left MCA branches have normal flow related enhancement, unchanged. There is irregularity and narrowing at the right P1/P2 junction with multiple collaterals, similar to the prior exam. The left P1 segment is better visualized than the prior exam without stenosis, likely due to differences in technique. The vertebral and basilar arteries are normal without evidence of stenosis or aneurysm.Numerous suprasellar collaterals appear similar to the prior exam. Right MCA collateralization from a transposed superficial temporal artery is unchanged.
1.Chronic ischemic changes appear overall similar to the prior exam with minimal, if any, increase in T2 signal. No evidence of acute ischemia.2.Arterial changes of moyamoya, most significant in the right distal ICA, are likely unchanged accounting for differences in technique. A few regions of apparent stenosis on the prior exam, including the right A1 segment and left P1 segment, appear normal on the current exam which is likely due to differences in technique (3T versus 1.5 T, also with prior artifact). Recommend requesting future MRA exams be done only on 3T MRI.