Clinical question: 20 y/o F with history of relapsed CNS pre-B cell ALL requiring whole brain XRT in 2012; baseline MRI upon entry into long term survivor clinicSigns and Symptoms: History of brain XRT The CSF spaces are larger than expected for the patient's stated age of 20 years with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Periventricular and subcortical white matter signal changes of a mild degree are present which are nonspecific. They could be post treatment related though they could also be vascular related, related to demyelination, trauma, vasculitis, sarcoid. They are nonspecific. 2.Mild generalized brain atrophy is redemonstrated but not progressed.