Male, 5 years old. History of neuroblastoma now with bruising around left eye. The new lobular, T1 hypointense, T2 heterogeneous mass within the left masticator space and infratemporal fossa measuring approximately 4.0 cm has diffuse heterogeneous enhancement and diffusion restriction. There is a small enhancing lobule extending cranially into the posterior aspect of the left lateral extraconal space with mild mass effect on the lateral rectus muscle (series 801, image 8). There is focal narrowing of the proximal optic canal with decreased visualized fluid within the optic nerve sheath at this level, but the nerve does not appear invaded by tumor.There is a cordlike area of enhancement along the left V2 nerve through the foramen rotundum. There is loss of the lateral wall cortex of the vidian canal with nodular enhancement superomedially. There is diminished caliber of the left pterygomaxillary fissure and pterygopalatine fossa without frank enhancement within the structures. There is extension of the tumor through the widened left foramen ovale into the extradural space in the middle cranial fossa inferior to the temporal lobe (series 701, image 5). There is an extradural enhancing nodule measuring 7 x 6 cm adjacent to the inferior left frontal lobe laterally (series 801, image 3), compatible with tumor extension, with subtle FLAIR abnormality in the adjacent brain parenchyma seen on prior noncontrast MRI. There is a an additional small enhancing lobulation anterior to the left temporal lobe (series 801, image 9).Additionally, there is new/increased masslike enhancing soft tissue surrounding the mandibular rami, right greater than left (series 701, image 4) which is favored to represent additional tumor, although there may be a component of adjacent local lymphadenopathy as well. These areas of soft tissue demonstrate diffusion restriction. The vestibular rami marrow signal is now STIR hyperintense, further suggesting osseous involvement. Additional small cervical lymph nodes are partially imaged. There is scattered mild paranasal sinus mucosal thickening.There is no evidence of intracranial hemorrhage or acute infarct. There is mild mega cisterna magna. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is scattered mild paranasal sinus mucosal thickening as well as scattered mastoid air cell opacification bilaterally.
1. An enhancing 4 cm mass in left masticator space/infratemporal fossa with extension into the left orbit, along the V2 and V3 cranial nerves as detailed above. There is extradural extension into the left middle cranial fossa, with mild mass effect on the adjacent inferior temporal lobe, consistent with neuroblastoma. Dedicated skull base CT imaging can be obtained for further evaluation of skull base osseous involvement.2. Additional enhancing soft tissue surrounding the STIR hyperintense mandibular rami, right greater than left, is consistent with additional tumor, although there may be a component of adjacent local lymphadenopathy as well.