 There is redemonstration of the infiltrating nonenhancing mass involving the hypothalamus extending into the optic chiasm, thicker on the left side. It measures 16 x 21 x 14 mm (1101/7, 1201/15) compared to 17 x 20 x 13 mm, and remains similar to baseline. There is redemonstration of focal thickening of the contiguous left prechiasmatic optic nerve likely also relating to tumor involvement.Dedicated images through the sella demonstrate a normal height of the pituitary gland. No focal abnormal signal intensity or mass is seen within the pituitary gland. The pituitary stalk lies in the midline. Suprasellar cistern, optic chiasm, cavernous sinuses and intracranial portions of the optic nerves appear unremarkable. There is redemonstration of patchy areas of T2/FLAIR hyperintensity along the deep gray nuclei, cerebral peduncles, brainstem, cerebellum as well as within the left amygdala/medial temporal lobe, where there is also mild expansion without enhancement. There is slight interval fluctuation of these findings, with slight increased size of the rounded left cerebellar lesion (now measuring up to 12 mm, compared to previous 7 mm) as well as of the medial right basal ganglia lesion. Other areas including within the cerebellar white matter appear slightly less prominent. Faint linear susceptibility is again noted along the right precentral gyrus which may relate to a capillary telangiectasia. There is no diffusion abnormality. The ventricles and basal cisterns are within normal limits. There is no midline shift or herniation. There is no extra-axial fluid collection. The major cerebral flow voids are intact.
1.Continued stable appearance of presumed hypothalamic/optic glioma with mild extension to involve the left prechiasmatic optic nerve.2.Slight interval fluctuation of FASI as detailed above. No significant associated mass effect.3.Continued mild expansion with abnormal signal involving the left mesial temporal lobe. Continued follow-up is recommended to evaluate for possible primary neoplasm.4.Unremarkable MR appearance of the pituitary gland.