 ORBITS: There is questionable minimal T2 hypertensity within the intraorbital segment of the left optic nerve only seen on the axial STIR sequence as well as minimal expansion within it's intracranial segment extending to involve the left aspect of the chiasm which shows asymmetric expansion. There is no associated enhancement. The right optic nerve and right side chiasm are unremarkable. The extraocular muscles are unremarkable. There is a 12 x 12 mm nonenhancing hypothalamic mass located just posterior to, and intimately associated with, the optic chiasm. There is mild splaying of the optic tracts by this lesion that extends posteriorly into the interpeduncular cistern. The infundibulum and pituitary gland are not involved.BRAIN: There are scattered patchy foci of T2 hyperintensity within the basal ganglia, thalami, cerebral peduncles, brainstem, and bilateral cerebellar white matter as well as within the left insula where there is also mild expansion without enhancement. There is a 3 mm focus of enhancement within the right precentral gyrus with subtle corresponding T2 signal abnormality. There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable.
1.Hypothalamic glioma likely extends toward the optic chiasm especially toward left side with resultant mass effect.2.Stigmata of NF1 including intracranial left optic nerve / chiasm enlargement most compatible with glioma and numerous supratentorial and infratentorial foci of signal abnormality compatible with "UBOs". The left hippocampal "UBO" demonstrates mild expansion and mass effect suggestive of low grade glioma. Follow-up imaging is recommended. 3.Small focus of enhancement within the right precentral gyrus with subtle associated T2 hyperintensity is nonspecific and may represent a vascular lesion such as a capillary telangiectasia, a neoplasm, or less likely artifact. Follow-up imaging is recommended. 