Eval growth of anaplastic astrocytoma. Pt on Avastin+CCNU. Along the posterior right superior frontal gyrus, there is increased extent and confluence of DWI hyperintensity with ADC isointensity in the location of previous focal DWI hyperintensity. This lesion measures 1.8 x 1.3 cm (series 11 image 27). There is corresponding increase in FLAIR/T2 signal and enhancement of this lesion. Questionable mild hyperperfusion conforming to the signal abnormality.There is mild residual patchy speckled enhancement remaining of the previously seen left paracentral lobule lesion. There is corresponding focal diffusion restriction appearing similar to prior study. Compared to more remote prior exams there is increase confluence of the T2/FLAIR hyperintensity in the left centrum semiovale. Compared to most recent prior exam, this region appears similar without enhancement or hyperperfusion.There is redemonstration of a small focus of enhancement with associated T2/FLAIR hyperintensity laterally adjacent to the left occipital horn, with stable post-contrast appearance, and stable to minimally progressed FLAIR abnormality. There is more conspicuous progression when compared to remote exams. It is associated with a faint susceptibility.Ill-defined gyriform enhancement along the posterior aspect of the left temporal lobe appears similar to the most recent comparison, with associated ill-defined FLAIR hyperintensity which is overall decreased immediately in the area of enhancement, although appears similar with gyral thickening as well as focal sulcal effacement just inferiorly.There are two new tiny nodular foci of enhancement seen adjacent to the left occipital periventricular and left posterior temporal lobe lesions with FLAIR abnormality, as seen on 11/15.Other scattered non-enhancing foci of FLAIR hyperintensity in the bifrontal and right parietal subcortical white matter appear unchanged, and are nonspecific. Susceptibility artifacts along the left frontal craniotomy site and left thalamus, stable from prior study. There is stable intrinsic T1 hyperintensity along the left thalamus, with subtle minimal superimposed enhancement especially along the medial left thalamus.Right ethmoid mucous retention cyst.
Redemonstration of multiple scattered ill-defined enhancing lesions scattered in both cerebral hemispheres of the brain, with some findings stable, although there are others which are progressed such as in the posterior right superior frontal gyrus with mild diffusion restriction and questioned hyperperfusion, as well as a few new tiny lesions in the left temporo-occipital white matter.