Diagnosis: Hemangioma of intracranial structuresClinical question: 3 T Scanner, QSM, permeability, CCM Protocol The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 7 x 9 mm axial dimension lesion centered in the midbrain with heterogeneous signal centrally on T1 and T2 and a low signal ring. It has a popcorn-like appearance it previously measured similar dimensions in 2014 but was larger in 2004. There is no associated DVA appreciated.There is redemonstration of a well-circumscribed heterogeneous mass in the left half of the genu of the corpus callosum measuring 18 x 13 mm axial dimensions It is heterogeneous with predominantly high signal on T1 weighted imaging within its central portion. It has multiple septations and a low signal rim on all pulse sequences. There is extensive susceptibility effect associated with this. It protrudes into the frontal horn of the left lateral ventricle. It measured similar dimensions in 2014 but was larger in 2004. There is no associated DVA appreciated.There are multiple punctate lesions scattered in both hemispheres of the brain as well as in the brainstem which are low signal on susceptibility weighted imaging.There are multiple foci of marrow replacement and enhancement scattered throughout the calvarium. Since the previous exam in 2004 the appear to be more numerous, however, since the 2014 exams they are approximately the same.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.There is redemonstration of cerebral cavernous malformations in the genu of the corpus callosum and midbrain which are stable since 2014.2.Punctate lesions throughout the supratentorial brain and brainstem are nonspecific but could represent small cerebral cavernous malformations.3.Multiple small calvarial lesions are present. These are nonspecific though they could represent hemangiomas. They are more numerous since 2004 but approximately the same since 2014.