 Examination is limited without intravenous contrast.There is a somewhat suspicious 0.9 x 1.4 cm T2/FLAIR hyperintense lesion involving the superior frontal gyrus of the right frontal lobe. There is a punctate focus of diffusion restriction in this region which may be related to tumor as opposed to ischemia. There is an additional 8 mm rounded focus of T2/FLAIR hyperintensity in the right temporal lobe (series 4, image 13), possibly also a metastasis. There are several additional punctate T-2/FLAIR hyperintense lesions which are nonspecific. For example there is a 2 mm lesion in the left frontal lobe (series 4, image 22). In addition there is a 4 mm lesion in the right temporal lobe (series 4, image 17). There is a punctate focus of susceptibility in the right frontal lobe compatible with microhemorrhage and nonspecific.The cortical sulci are in proportion to the cerebral ventricles. No intra-axial or extra-axial fluid collections are visualized. There is no midline shift or mass effect. The basal cisterns are visualized. No fluid collections are visualized in the paranasal sinuses and mastoid air cells.
1. Please note lack of contrast significantly limits evaluation for small metastatic lesions. A 1.4 cm lesion in the right frontal lobe and an 8 mm lesion in the right temporal lobe are somewhat suspicious for metastatic disease. There is punctate focus of restricted diffusion in the region of the right frontal lobe lesion which may be related to tumor itself rather than represent a punctate infarct.2. Several additional punctate nonspecific foci of T2/FLAIR hyperintensity are demonstrated which may relate to chronic microvascular ischemic disease but also nonspecific. As renal function allows, would suggest considering postcontrast CT or MRI for further evaluation. Alternatively, follow-up MRI may be obtained to assess for enlargement. There is otherwise no large mass or evidence of mass effect intracranially.