Primary CNS lymphoma, please restage. Please note lack of contrast limits evaluation for tumor recurrence. Again seen are postoperative findings related to left transfrontal biopsy. There is unchanged confluent T2 hyperintensity and susceptibility effect in the superior left frontal lobe without associated mass effect or restricted diffusion. There is also unchanged scattered cerebral white matter T2 hyperintensity, particularly in a periventricular distribution, which is compatible with chronic small vessel ischemic and/or posttreatment changes. There is no evidence of acute infarct. There is global parenchymal volume loss commensurate with patient's advanced age. No hydrocephalus. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged, including a left occipital scalp lipoma.
Lack of contrast again limits evaluation for tumor recurrence. There is no significant change in FLAIR hyperintensity involving the left frontal lobe, which while nonspecific, is favored to represent posttreatment change. No new mass or mass effect to suggest tumor recurrence. 