61 years, Female, history of ALL undergoing clinical trial with new complaints of headaches Compared to prior examination from 14/2016, there has been interval development of leptomeningeal enhancement involving the sulci of the left occipital and temporal lobes. There is also dural thickening and enhancement along the left temporal and occipital convexities. There is corresponding diffusion hyperintensity. There is abnormal T2/FLAIR hyperintensity involving the adjacent cortex as well as nonsuppression of CSF on the FLAIR sequences. There is no intracranial mass effect, midline shift, or herniation. Ventricles are not significantly changed in size since prior. There is patchy FLAIR hyperintensity involving the bilateral frontoparietal white matter which has mildly increased when compared to the prior available FLAIR sequence from 1/13/2016 and likely represents treatment-related change. No evidence of acute ischemia or hemorrhage. There is heterogeneity of the bone marrow which is nonspecific and may be related to known leukemia. No destructive calvarial lesions are appreciated. There is moderate mucosal thickening involving the right maxillary sinus with fluid levels and frothy secretions which may represent acute sinusitis in the appropriate clinical setting. There is minimal mucosal thickening elsewhere in the paranasal sinuses.
1. Compared to prior exam from 1/14/2016, there has been interval development of abnormal leptomeningeal as well as dural enhancement in the left temporal and occipital lobes. Finding is favored to represent neoplastic meningeal infiltration, presumably from known leukemia. Inflammatory/infectious process seems less likely but can be correlated with CSF analysis.2. Slight increase in FLAIR hyperintensity involving the frontoparietal white matter likely representing posttreatment change.3. Moderate mucosal thickening involving the right maxillary sinus with fluid levels and frothy secretions, which may represent acute sinusitis in the appropriate clinical setting.