Male, 68 years old, with history of pachymeningitis, receives annual MRI of the brainstem, last MRI 5/15. Evidence of right temporal craniotomy is seen. There is a small resection cavity within the adjacent right middle temporal gyrus.A small focus of bright signal on the diffusion sequence within the right corona radiata does not show a correlating ADC abnormality and therefore probably represents T2 shine through artifact. Scattered additional small T2 hyperintense lesions are evident within the cerebral hemispheres which are nonspecific. No evidence of parenchymal edema or mass effect is detected. No evidence of acute intracranial hemorrhage or any abnormal extra axial fluid is seen. On postcontrast images, minimal generalized dural thickening is seen with no areas of focal nodularity. No abnormal enhancement is seen within the basal cisterns or along the cranial nerves. No pathologic parenchymal enhancement is detected. Note is made, however, of ill-defined enhancement within the intraconal space of the orbits. This is only visualized on the fat-suppressed axial images.Redemonstrated is evidence of pan-sinus mucosal thickening and secretions. Bone marrow signal characteristics are unremarkable.
1.Evidence of right temporal craniotomy and biopsy from the right middle temporal gyrus is seen.2.Scattered nonspecific T2 hyperintense lesions are evident within the cerebral hemispheres. These are most likely related to chronic microvascular ischemic disease.3.Mild diffuse dural thickening is seen which is nonspecific but may potentially be related to the patient's history of pachymeningitis.4.Note is made of ill-defined enhancement within the intraconal orbits. This may represent vascularity or vascular congestion, though if concern for orbital pathology exists, dedicated orbital imaging can be considered.