DLBCL recurrent in CSF. Now receiving IT rituximab. Brain: There is increased patchy T2 hyperintensity and enhancement in the medial right basal ganglia region. There is increase in size of a lesion in the right basal ganglia region with enhancement along the margin of the right frontal horn. There also appears to be new T2 hyperintensity along the bilateral cerebellar tonsils. There is persistent infiltrative abnormal enhancement involving the optic apparatus. There are unchanged nonspecific foci of T2 hyperintensity without corresponding enhancement in the cerebral white matter. There is no evidence of acute infarction or intracranial hemorrhage. There is a right transfrontal Ommaya catheter that terminates in the right lateral ventricle. There is no significant interval change in the size of the ventricular system. There is no midline shift or herniation. There is moderate right maxillary sinus mucosal thickening and an apparent fluid level in the left maxillary sinus. There is mild fluid signal within the mastoid air cells.Spine: There is no evidence of mass lesions or abnormal leptomeningeal enhancement in the spine. There is loss of the usual cervical and lumbar lordosis, but the thoracic vertebral column alignment is within normal limits. The vertebral body heights are preserved. There is degenerative spondylosis at multilevel levels of the cervical spine with mild spinal canal stenosis. The vertebral bone marrow signal is unremarkable, aside from degenerative endplate signal alterations. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.
1. Persistent infiltrative abnormal enhancement involving the optic apparatus likely related to involvement by lymphoma. 2. Increase in size of a lesion in the right basal ganglia region with enhancement along the margin of the right frontal horn and involving the cerebellar tonsils also likely represent involvement by lymphoma. 3. No evidence of leptomeningeal disease in the spine.4. Findings suggestive of acute sinusitis.