24-year-old with anaplastic astrocytoma status post proton RT and on TMZ. Again seen are postoperative changes from left parietal craniotomy and remote ependymoma resection. Resection cavity is CSF filled and appears to communicate with the atrium of the left lateral ventricle. Again seen is a cystic focus anterior to the resection cavity related to recent biopsy with susceptibility artifact indicating postbiopsy blood products.Compared to most recent MRI from 1/17/2016 and dating back to 9/30/2015, there is slight further interval decrease in the extent of abnormal T2 signal within the white matter of the left parietal, temporal, and frontal lobes. The masslike thickening of the posterior corpus callosum and cingulate gyrus has resolved. Slight decrease in signal abnormality involving the left thalamus with T1 and T2 hyperintensity also noted. Slight decrease in signal abnormality involving the posterior callosum/splenium extending into the right also noted.A more nodular area of increased T2 signal in the subcortical white matter of the left inferior parietal lobule is not significantly changed. Most recent comparison study was obtained without gadolinium however when compared to MRI brain from 9/30/2015, there is interval development of nodular enhancement in the left inferior parietal lobule which measures 9 x 7 mm associated with the nodular T2 hyperintense focus mentioned above. Enhancement involving the left posterior thalamus is again seen. Punctate nodular enhancement more laterally in the subcortical left temporal white matter was also present previously. Punctate enhancement lateral to the left parietal resection cavity is no longer seen. Mild increase in enhancement medial and lateral to the posterior body of the left lateral ventricle also noted.A cavernous malformation within the central pons is not significantly changed from prior. There are additional punctate foci of susceptibility related to chronic microhemorrhages involving the left parietal, and temporal lobes.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. There has been significant increase in opacification of the left maxillary sinus as well as increased opacification of the right maxillary sinus. Right sphenoid sinus opacification appears improved. Opacification of the left greater than right ethmoid air cells is slightly worse. The visualized mastoid air cells are clear.
1. Compared to 1/7/2016 and 9/30/2015, there is continued decrease in T2/FLAIR signal abnormality within the white matter of the left temporal and parietal lobes, more noticeable when compared to study from 9/30/2015. There remain areas of abnormal increased T2/FLAIR signal centered within the left periatrial white matter and inferior parietal lobule related to known tumor. When compared with post gadolinium sequences from 9/30/2015, there is interval increase in nodular enhancement associated with the nodular lesion in the left inferior parietal lobule. Additional adjacent nodular areas of enhancement described above demonstrate stability, slightly increased, or slightly decreased compared to 9/30/2015. As such these findings may represent posttreatment changes but suggest attention on follow-up, particularly of the inferior parietal lobule lesion with nodular T2/FLAIR signal.2. Again seen is a separate left parietal resection cavity related to prior ependymoma resection without findings to suggest ependymoma recurrence.3. No significant change in pontine cavernous malformation.4. Increased paranasal sinus opacification.