Metastatic nasopharyngeal cancer status post treatment. There is interval decrease in size of the enhancing lesion in the anterior left temporal pole, but a subcentimeter enhancing lesion in the right anterior temporal pole is slightly larger. There are scattered foci of high T2 signal in the cerebral white matter bilaterally. There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mucosal thickening and fluid within the right maxillary sinus. There are post-treatment findings in the nasopharynx, with diffuse mucosal enhancement, but no definite tumor, although the exam is not optimized for assessment of this region. The orbits, skull, mastoid air cells, and scalp soft tissues are grossly unremarkable.
1. Interval decrease in size of the enhancing lesion in the anterior left temporal pole, but a subcentimeter enhancing lesion in the right anterior temporal pole is slightly larger. These lesions likely represent evolving radiation necrosis.2. Scattered foci of high T2 signal in the cerebral white matter bilaterally may represent chronic small vessel ischemic disease, but no evidence of acute infarct. 3. Findings suggestive of acute right maxillary sinusitis.4. Post-treatment findings in the nasopharynx, with diffuse mucosal enhancement, but no definite tumor, although the exam is not optimized for assessment of this region. 