91 years, Male, ongoing headaches. Evaluate for new CNS lesions. Lacunar infarcts. Stable carcinoid tumor of the duodenum. No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement to suggest metastatic disease. No restricted diffusion to suggest acute ischemia. There is global parenchymal loss, commensurate with patient's age. Prominence of the CSF spaces in the posterior fossa likely related to mega cisterna magna. Several foci of T2/FLAIR hyperintensity are again seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. There are multiple scattered foci of susceptibility effect including a relatively larger focus in the right lateral occipital lobe (with subtle hyperdensity of CT suggestive of mild mineralization) as well as a small focus in the left cerebellar hemisphere which are unchanged. Tiny punctate focus is seen in the left parietal white matter which was not seen on prior study which may be related to differences in technique. These lesions are compatible with chronic microhemorrhages. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved. There is mild mucosal thickening involving the paranasal sinuses. Bone marrow signal and extracranial soft tissues are otherwise unremarkable.
1. No evidence of intracranial metastatic disease.2. Mild to moderate chronic small vessel ischemic changes.3. Multiple foci of susceptibility effect likely related to chronic microhemorrhages are grossly unchanged allowing for differences in technique. There is a relatively larger focus of chronic hemorrhage in the right lateral occipital lobe which is unchanged since 2009.