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Sinusitis. Ischemic changes, small FLAIR hyperintensities in bilateral frontal parietal lobes, flow voids within intracranial vessels. Help?

There are several small FLAIR hyperintensities seen within the deep white matter of the bilateral frontal
and parietal lobes. These measure less than 3mm in size. No restricted diffusion is seen. There is normal
signal intensity noted within the brain stem and cerebellum. No space occupying lesion is seen. There is no
extra-axial collection. The ventricles are symmetric and normal in size. No midline shift or mass effect is
seen. Normal flow voids are seen within the major intracranial vessels. The mastoid air cells are clear. The
orbits define normally.
There is extensive high signal change evident bilaterally in the maxillary sinuses, left sphenoid sinus with less
marked changes involving the bilateral ethmoid and right sphenoid sinus. The bilateral frontal sinuses appear
clear. Air fluid levels are noted within the left maxillary sinus.
The pituitary gland is non-enlarged. The midline structures define normally. The optic nerves define normally
bilaterally and there is no mass effect on the optic chiasm.

There is extensive abnormal signal change evident in the paranasal sinuses predominantly involving the bilateral
maxillary and sphenoid sinuses with less marked changes in the ethmoid sinuses. This most likely represents
mucosal inflammatory changes. Air fluid level is noted in the left maxillary antrum, suggestive of acute
sinusitis. Correlation with CT para nasal sinuses is recommended.

Several small FLAIR hyperintensities are noted within the deep white matter. These are non-specific in
appearance. The distribution is not typical for demyelination. The appearances are not considered typical for
chronic small vessel ischaemic changes in this age group. Follow-up MRI scan is recommended in 6 months.
Asked On : Tue, 16 Apr 2013
Answers:  1 Views:  227
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Radiologist 's  Response

The extensive mucosal inflammatory changes and air fluid level within the sinus represent features of acute sinusitis. You may need to consult and ENT specialist to evaluate the sinuses, especially you have any symptoms of sinusitis (eg: headache, pain over the face, stuffed or runny nose, etc). You probably do not require a CT scan unless your specialist asks for one.

The FLAIR hyperintensities in white matter are non-specific. The description fits that of Fazekas Grade 1 changes which are of no significance or worry, especially if you are above 40-50 years of age. However, if they worsen on follow up MRI, especially in young patients (less than 40 years), it maybe an indicator for predisposition to development of dementia early in life.

Hope this helps,

Answered: Sat, 20 Apr 2013
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