Male, 54 years old, with NASH cirrhosis, complicated by hepatic encephalopathy on lactulose, still with mental slowing, particularly speech. Image quality is degraded on some sequences by motion artifact. Within this limitation, the following observations are made.Intrinsic T1 hyperintensity within the basal ganglia bilaterally, predominantly the globus pallidus, is unchanged from prior. There may in addition be scattered foci of intrinsic T1 hyperintensity within the white matter of the corona radiata and centrum semiovale which appears more prominent than on the prior examination.Patchy ill-defined T2 hyperintense lesions within the bilateral cerebral white matter are again seen. Accounting for imaging artifact and differences in technique, there does not appear to be any significant interval change.No evidence of significant parenchymal edema or mass effect is seen. No parenchymal restricted diffusion is detected. There is no evidence of acute intracranial hemorrhage or any abnormal extra-axial fluid collection. The ventricles are normal in size and morphology.The bone marrow of the calvarium demonstrates diffusely hyperintense signal on diffusion-weighted and FLAIR imaging, and diffuse enhancement on postcontrast sequences, findings which seem to have progressed slightly from the prior examination.
1.Intrinsic T1 hyperintensity within the basal ganglia, and also scattered through the cerebral white matter, is seen, likely related to chronic hepatic dysfunction. The signal abnormality has perhaps progressed within the cerebral white matter though technical differences could contribute to the apparent change.2.Scattered white matter T2 signal abnormalities are again seen without significant interval change. No evidence of parenchymal edema or mass effect is identified. No enhancing parenchymal or leptomeningeal abnormality is seen.3.The marrow of the calvarium demonstrates signal characteristics suggesting elevated cellularity or infiltration. The etiology of these findings is uncertain, though in the setting of anemia, marrow reconversion could produce these findings.