Clinical question: Evaluate grade 3 oligodendroglioma status post RT and TMZ. Signs and symptoms: As above. Pre and post enhanced brain MRI:Examination redemonstrates extensive postoperative changes of right anterior temporal lobectomy since prior study. There is stable FLAIR and T2 hyperintensity of the right temporal lobe immediately posterior to the surgical resection site which extends into the left basal ganglia consistent with encephalomalacia/gliosis and postoperative changes. There is no detectable focus of abnormal enhancement at the surgical site or remote to the surgical site. This is a similar observation is prior exam.Moderate to be enlarged supratentorial ventricular system with maintained midline remain similar to prior study.Focus of encephalomalacia in the left anterior frontal lobe without abnormal enhancement or interval change since prior study.Scattered periventricular and subcortical FLAIR and T2 hyperintensity foci suggestive of chronic small vessel ischemic strokes are again noted without interval change. Possibility of overlapping post treatment/radiation changes cannot be excluded. Correlate with clinical history.Diffusely prominent cortical sulci and CSF spaces also remains identical to prior exam.
1.No evidence of an acute or definitive new finding since prior exam.2.Stable postoperative/therapy changes of the right anterior temporal lobectomy without abnormal enhancement to suggest recurrence of tumor.3.Stable scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter and a focus of encephalomalacia in the left anterior and inferior frontal lobe similar to prior exam.4.Stable scattered foci of FLAIR hyperintensity and localized focus of encephalomalacia in the left frontal lobe since prior study.5.Stable moderately enlarged supratentorial ventricular system and generalized prominence of cerebral cortical sulci likely representing ex vacuo dilatation.