You should say also what was the motive for performing this MRI and the 2009 one, what are the symptoms their progression in time, prior illnesses. The MRI report alone is not enough and the following is just assumptions. As for the report alone, if you were younger it would be suspicious for a demielinating disease like MS, but at 68 while not impossible it is not likely to be the case so I wouldn t be alarmed. The other possibilities refer to the remains of an old process the origin of which in the absence of other data can not be determined whether stroke, infection or something else (like an old scar). It s not active though so this option is not alarming either. Of course the report wisely recommends to compare with old MRI, if the lesion was present there as well and has not changed that renders MS or any active disease even less likely. A follow up MRI is suggested for the same reason to see if things remains unchanged or if there are new signals in other areas of the brain or spinal cord which would indicate an active process.