Female, 48 years old, with pulsatile tinnitus and white matter lesion. Assess for change in white matter lesion. Again seen is an area of ill-defined T2 hyperintensity spreading from the left periatrial white matter superiorly into the left postcentral gyrus. The overall size and extent of this lesion have not significantly changed. The lesion is somewhat more distinct on the current examination, possibly due to imaging at 3 Tesla. As before, this lesion induces no mass effect and there is no associated pathologic enhancement. Single voxel spectroscopy of this lesion demonstrates a nonspecific elevation of choline relative to the contralateral normal side. The NAA level is unaffected. No unexpected metabolite resonances are seen.A punctate focus of T2 hyperintensity is seen within the right orbital gyrus, unchanged and nonspecific. No new areas of parenchymal signal abnormality are seen. No pathologic parenchymal enhancement is detected. Redemonstrated is a 5 mm lobular focus of enhancement within the left cerebellopontine angle cistern adjacent to the petrosal vein which is unchanged.No restricted diffusion is seen. No abnormal extra-axial fluid or evidence of intracranial hemorrhage is seen. The ventricular system is normal in size and morphology. Patchy, moderately severe paranasal sinus mucosal thickening is seen, similar to prior.
1.No significant interval change is seen in the overall size of a nonenhancing ill-defined T2 hyperintense lesion in the left parietal lobe. Single voxel spectroscopy of this lesion shows a nonspecific degree of choline elevation with preserved NAA. Differential diagnosis would continue to include both non-neoplastic and neoplastic etiologies including sequela of prior inflammation or demyelination, dysplastic tissue, or low-grade neoplasm.2.Stable lobular enhancing structure within the left cerebellopontine angle cistern which may represent a focally dilated vascular structure, probably venous.