Malignant neoplasm of connective and soft tissue, unspecified [C49.9] / Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49] / Secondary malignant neoplasm of liver and intrahepatic bile duct. Significant motion artifacts especially for the postcontrast images. Since the comparison of the post contrast scans are essential part of the exam, the exam can be repeated at 3T scanner without additional charge if clinically indicated.There are multifocal fusiform enhancement of bilateral distal intracranial arteries indicating possible intracranial vasculitis. In particular, comparing to prior scan, there are interval decrease in enhancing lesions including bilateral distal ACA, left MCA M2, M3 and M4 branches, and right PCA indicating decreased inflammatory infiltration of distal arterial wall.Right inferior frontal sulcus T1 high signal intensity lesions may indicate intravascular thrombus or arterial wall thickening which do not show any significant interval change. Adjacent brain parenchymal FLAIR high signal intensities are again seen, unchanged since prior scan.Considering above findings, previously seen right posterior inferior temporal lobe focal encephalomalacia could come from prior rupture of PCA branch fusiform aneurysm. Again the extent of the encephalomalacia is unchanged but less enhancement. There is no evidence of acute ischemic or hemorrhagic lesion on this scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.
1. Unchanged extent of the right posterior inferior temporal lobe lesion but less enhancement.2. Multifocal bilateral intracranial vascular wall enhancement suggesting the feature of intracranial vasculitis with interval improvement of some of previously seen lesions. 