Recurrent adenoid cystic carcinoma, status post radiation and surgery. There is no evidence of intracranial hemorrhage or infarction. There are scattered hypoattenuating foci in bilateral cerebral white matter, which may represent small vessel ischemic changes.Extensive post-treatment changes are again present involving the left orbit, maxillary region and upper neck. Again noted are enhancing soft tissue lesion involving the left orbit, extending to the orbital apex, superior and inferior orbital fissure. There is extension into the region of the left pterygopalatine fossa and left cavernous sinus. There is lesion involving the left nasopharyx and sphenopalatine foramen, with bony destruction at the floor of the sphenoid sinus and bone destruction of the left basisphenoid. There is soft tissue lesion overlying and lateral to the ramus of the left mandible. The lesion at the left lacrimal fossa measures slightly larger as 21 x 7 mm (image 12, series 3) compared to prior measurement of 19 x 5 mm (image 33, series 10). There is increased erosion of the lateral wall of the left orbit, with soft tissue lesion involving also the left temporalis muscle. The lesion overlying the ramus of the left mandible is also slightly increased.The enhancing lesions involving the anterior pole of the left temporal lobe, and enhancement in the left foramen ovale seen on prior MRI are not as well appreciated on this CT study and may be related to technical difference.There is patchy opacity in the right lung apex, which may represent inflammatory change. Degenerative disease of cervical spine is noted.
1. Enhancing lesions involving the left maxillary region and left orbit with extension into the left nasopharynx, left masticator space, sphenoid sinus, skull base, and left cavernous sinus as described above. There is subtle interval increase of the lesions as evident at lateral aspect of the left orbit and left masticator space.2. Enhancing lesion in anterior pole of the left temporal lobe seen on prior MRI study is not well-visualized and may be related to technical difference. This could potentially represent post radiation necrosis versus tumor brain parenchymal involvement. This can be further evaluated with MRI brain using skull base protocol. 