58 years Female (DOB:3/5/1958)Reason: primary CNS lymphoma s/p treatment History: please compare with previous MRI in the systemPROVIDER/ATTENDING NAME: CHADI NABHAN CHADI NABHAN The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post burr hole placement along the left parietal calvarium for a previous left parietal lobe stereotactic biopsy.There is confluent signal change present within the left periventricular subcortical white matter centered in the left parietal lobe which has extended further compared to the prior exam. The area involved canal measures 60 x 27 mm axial dimensions and previously measured 47 x 20 mm axial dimensions. There is no associated contrast enhancement. There is susceptibility effect within the left parietal lobe in the location where there was a ring-enhancing lesion on the 9/4/2015 exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR punctate hyperintense foci present in the range stem, internal capsules and deep gray nuclei.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since the prior exam, white matter changes associated with a left parietal lesion have extended further. It is conceivable that this white matter change is related to posttreatment change.2.No enhancing mass lesion is appreciated intracranially to suggest recurrence of the lymphoma.3.Periventricular and subcortical white matter lesions as well as punctate lesions in the deep gray nuclei and brainstem are nonspecific. They are most likely vascular related. 