64 years, Male, esophageal neoplasm. New onset confusion. Evaluate for brain metastases. There is no restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter. There is an additional focus of T2 hyperintensity within the right precentral gyrus, with curvilinear susceptibility, possibly small focus of hemorrhage with adjacent edema. There is no associated diffusion restriction or enhancement. There are prominent Virchow Robin spaces. Brain parenchyma is otherwise unremarkable for age.There is no abnormal meningeal enhancement. Major flow-voids are preservedThere is a mild rounded contour of T1 hyperintensity along the the posterior pituitary gland, which may represent a proteinaceous cyst or atypical appearance of the bright spot. Postcontrast images of the pituitary gland appear grossly unremarkable. The left lens is surgically absent. There is minimal mucosal thickening of the left maxillary sinus. Bone marrow signal and extracranial soft tissues are within normal limits.
1.Periventricular and subcortical T2 hyperintense foci are nonspecific, but statistically most likely to represent small vessel ischemic disease.2.Focus of susceptibility within the right precentral gyrus subcortical white matter, probably microhemorrhage with minimal adjacent edema.3.No enhancing lesion is identified.