26 years, Male, brain biopsy planning.. Examination is limited to sequences for operative planning and intraoperative navigation. Fiducial markers are in place. Again seen are intensely enhancing masses involving the left cingulate gyrus as well as more posteriorly in the precuneus of the left parietal lobe. There is surrounding edema which is minimally increased since prior. Masslike T2 signal abnormality involving the bilateral posterior corpus callosum body is also again seen. Additional nonenhancing foci of T2 hyperintensity involving the bilateral frontal and parietal lobes are also again seen with focus in the left frontal lobe appearing slightly more confluent with the vasogenic edema more posteriorly. These areas demonstrated restricted diffusion previously. Mass effect including downward displacement of the corpus callosum and partial effacement of the lateral ventricles again seen. There is minimal rightward midline shift at the level of the cingulate gyrus with no significant midline shift at the level of the foramen of Monro or evidence of uncal herniation. No hydrocephalus.
Examination for operative planning again demonstrating enhancing left frontal and parietal masses with additional smaller nonenhancing lesions. There is minimal interval increase in edema when compared to 5/26/2016. Lymphoma is again very high in the differential.