Metastatic papillary thyroid carcinoma status post total thyroidectomy, multiple neck dissections and radiation therapy. Most recent SRS to the right occipital resection cavity on 4/25/2014. Increased thyroglobulin. Again seen are postoperative changes of prior right occipital craniotomy. Compared to 11/11/2014 and 7/30/2014, there is slight increase in nodular thickening along the right paramedian occipital lobe resection cavity and posterior falx including a nodular focus of enhancement measuring approximately 1 cm in diameter along the right calcarine fissure. There remains T2/FLAIR hyperintensity along the margins of this resection cavity, slightly more focal anteriorly. No new lesion, new edema, or new mass-effect.The ventricles and sulci are prominent, consistent with moderate age-related volume loss. There is no midline shift or mass effect. Foci of susceptibility are seen again along the posterior right temporal lobe. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild-moderate chronic small vessel ischemic changes. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. No destructive lesions within the calvarium. Focus of T1 hyperintensity in the left frontal calvarium remains unchanged.Images of the neck demonstrate posttreatment changes related to total thyroidectomy, neck dissection, and radiation therapy. There is abnormal T2 hyperintensity involving the left true vocal cord and the inferior aspect of the left paraglottic fat which is favored to represent treatment-related change. There is sclerosis involving the left lateral aspect of the cricoid cartilage which is better seen on prior CT. No discrete mass is appreciated. No suspicious lymphadenopathy is seen. No suspicious osseous lesions. Mild degenerative changes are seen in the cervical spine.
1. Compared to 11/11/2014 and 7/30/2014, there is interval increase in enhancement along the margins of the right paramedian occipital lobe resection cavity including a nodular enhancing focus along the right calcarine fissure. Given history of radiation to this area in 4/2014, finding may represent evolving radiation change, however, suggest continued close follow-up to exclude possibility of local recurrence. Consider including perfusion sequence on next follow-up study. Otherwise no new lesions to definitively suggest progression of intracranial metastatic disease.2. No new neck mass or cervical lymphadenopathy.3. Abnormal T2 signal and enhancement involving the left true vocal cord, inferior paraglottic fat, and sclerosis of the left cricoid cartilage likely represents treatment-related change. Direct comparison MRI is not available and findings are grossly similar to prior CT neck from 8/19/2014. May consider direct endoscopic evaluation if clinically indicated.