Female with Right Frontal Hemispheric Dysplasia

Sagittal T1-weighted image (A) shows no definite abnormality. Axial FLAIR image (B) demonstrates subtle enlargement of the right hemisphere with focal areas of signal hyperintensity within the subcortical white matter of the right frontal and parietal lobes but without corresponding restricted diffusion on the axial diffusion weighted trace (C) image. Additionally noted is ipsilateral ventricular enlargement. Pachygyria was also demonstrated within the right frontal and parietal lobes, better demonstrated on more superior axial FLAIR images. 

Axial T2-weighted image (D) also demonstrates these findings. Sagittal T1-weighted image (E) shows no definite abnormality. Axial FLAIR image (F) demonstrates asymmetric cortical thickening, gyral enlargement within the right frontal and parietal lobes without restricted diffusion on the axial diffusion weighted trace (G) image, consistent with pachygyria. Coronal FLAIR image (H) reveals asymmetric cortical thickening, abnormal sulcation and white matter signal hyperintensity in the right parietal lobe. The group 1 reader described the right frontal lobe signal abnormality, but did not diagnose the full extent of the hemispheric abnormality. These findings are more apparent on the coronal FLAIR sequence, not available to the reader.