Female, 71 years old, with history of AVM status post treatment (SRS in January 2015). Evaluate for changes. The known arteriovenous malformation of the left superior frontal gyrus is redemonstrated as an area of ill-defined enhancement measuring 12 x 7 x 6 mm, previously 14 x 11 x 9 mm. As before, a mildly prominent draining vein extends to the adjacent dura. Of note, there is new mild FLAIR hyperintensity within the parenchyma surrounding the lesion. No significant local mass effect is seen.Elsewhere, numerous scattered foci of periventricular and subcortical white matter T2 hyperintensity are again seen without gross interval change. No evidence of significant parenchymal edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. A 9 x 5 mm dural-based enhancing nodule is evident along the high left convexity, unchanged. No new enhancing lesions are seen. The ventricular system is stable and normal in size.The field-of-view of the MRA inadvertently excludes the left superior frontal gyrus lesion. Elsewhere, no new vascular lesion or significant stenosis is observed. A 1 mm outpouching from the left P1 segment is unchanged and favored to represent an infundibulum rather than an aneurysm.
1.Enhancement pertaining to the left superior frontal gyrus arteriovenous malformation has decreased. However, new mild FLAIR hyperintensity has developed surrounding the lesion. In the absence of detectable mass effect, this may reflect treatment related gliosis, but continued imaging follow-up will be required.2.MRA imaging inadvertently excludes the left superior frontal gyrus lesion. The patient will be brought back to repeat this imaging sequence at no additional charge. The MRA examination is otherwise unremarkable.3.Elsewhere in the brain, scattered white matter lesions are seen which may reflect chronic microvascular ischemia. No new or acute lesions are detected. A small dural based enhancing nodule along the high left convexity may represent a dilated venous structure or a meningioma.