 Lack of contrast limits evaluation of neoplasm.Brain: There is extra-axial T1 hyperintensity along the posterior aspect of the petrous temporal bones favored to represent a small subdural hematoma and new since prior. No significant mass effect.Extra-axial left frontal mass demonstrates decrease in size, measuring approximately 12 mm in diameter in the axial plane, previously 28 mm measured similarly. Mass demonstrates decrease in intrinsic T1 and T2 signal. Surrounding FLAIR hyperintensity/edema has decreased. There is also reexpansion of the frontal horn of the left lateral ventricle related to decreased mass effect. Additional nonspecific scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are not significantly changed.Note small extra-axial lesions can be better assessed with postcontrast imaging. Extra-axial left occipital lesion demonstrates decrease in size, previously approximately 7 mm and infiltrating the adjacent calvarium, now not definitively appreciable. No new intracranial mass or new mass effect. No midline shift or herniation. No hydrocephalus. Low-lying cerebellar tonsils again seen. Diffuse T1 hypointensity of the bone marrow signal is again seen compatible with history of multiple myeloma. Neck:There is an infiltrative appearing mass involving the right maxilla with soft tissue extension laterally into the right buccal space. The mass measures approximately 3.6 x 3.3 x 3.5 cm in the AP, transverse, and craniocaudal dimensions (ax T1 series 18, image 31 and sag T1 series 8 image 14). This region is partially included on the prior brain MRI with questionable minimal if any signal abnormality in this region on prior study. There is increase in opacification of the right maxillary sinus with low T1 and T2 signal suspected to represent direct invasion of the tumor into the right maxillary sinus. Small underlying osseous erosions of the right maxillary sinus wall can be better assessed with CT.Multiple ovoid lesions likely representing lymphadenopathy are present in the neck at levels 1B and 2 bilaterally as well as level 3 on the right. For example a right level 2B lymph node measures 20 x 13. A left level 2A lymph node measures 12 x 12 mm. Airway is patent. Diffuse T1 hypointense marrow signal abnormality is noted in the cervical spine which may related to known leukemia or myeloma. No obvious epidural tumor. Mild multilevel degenerative changes without high-grade spinal canal stenosis.
1. Compared to MRI dated 6/15/2016, there is interval decrease in size of the previously seen multiple intracranial extra-axial lesions. Residual lesions can be better assessed with post gadolinium imaging.2. New area of extra-axial T1 hyperintensity in the posterior fossa favored to represent small subdural hematomas without associated mass effect. These may conceivably be related to redistribution of blood products associated with the previously seen extra-axial lesions.3. Interval development of a right maxillary mass most consistent with a tumor deposit which appears to infiltrate into the maxillary sinus and extend laterally into the buccal space. 4. Bilateral cervical lymphadenopathy, predominantly on the right.