 There is no abnormal parenchymal or meningeal enhancement. No intracranial mass or mass effect. Again seen is extensive confluent T2/FLAIR hyperintensity in the bilateral frontoparietal and to a lesser degree temporal and occipital white matter most compatible with treatment related leukoencephalopathy. There are multiple scattered foci of susceptibility effect including the bilateral temporal lobes and cerebellar hemispheres which are grossly similar to prior. There is focus of susceptibility in the left posterior frontal lobe which is not definitely seen on prior and may be due to differences in technique and the small size of the lesion. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. There is aneurysm involving the right supraclinoid internal carotid artery which measures approximately 9 mm in diameter and 11 mm in the craniocaudal dimension, similar to prior. Left maxillary mucous retention cyst again seen. The enhancing lesions that were seen in the previous study involving the left frontal calvarium at the vertex and the right parietal calvarium are grossly unchanged.
1. No evidence of intraparenchymal or leptomeningeal metastatic disease.2. Enhancing foci in the right parietal and left frontal calvarium which were seen on prior study from 5/15/2015 but not on more remote prior studies are not significantly changed. 3. No significant change in extensive supratentorial white matter abnormality most compatible with treatment-related leukoencephalopathy.4. No significant change in scattered punctate foci of chronic microhemorrhages which are nonspecific and can be seen with entities such as chronic hypertension as well as sequela of radiation treatment. 5. Right supraclinoid internal carotid artery aneurysm again seen and grossly similar in size to priors but can be better evaluated with dedicated MR or CT angiogram.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.