73Yrs male with multiple medical problems and recently diagnosed bulky stage 4 non-GCB DLBCL History: Change in mentation, increased confusion. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Susceptibility sensitive sequence is motion degraded limiting assessment for small foci of hemorrhage, although no obvious hemorrhage is evident within this limitation.There are patchy foci of T2/FLAIR hyperintensity in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with moderate degree of chronic small vessel ischemic disease. There is also more notable T2/FLAIR hyperintensity involving the pons which is nonspecific but in association with the supratentorial findings is favored to to be related to chronic small vessel ischemic disease. No associated restricted diffusion or enhancement.No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. There is mild mucosal thickening involving the left maxillary sinus as well as minimal scattered ethmoid opacification.
1. No evidence of intracranial neoplasm. No evidence of acute infarct or intracranial mass effect.2. Patchy FLAIR signal abnormality in the periventricular and subcortical white matter is nonspecific but likely related to moderate chronic small vessel ischemic disease. T2/FLAIR hyperintensity in the pons is favored to be related to chronic small vessel ischemic disease given the supratentorial findings; however, osmotic demyelination involving the pons can be considered in the appropriate clinical setting.