Reason: Jay has mosaic neurofibromatosis and bilateral optic nerve gliomas s/p chemotherapy History: off therapy evaluation There is redemonstration of a oval T2/FLAIR hyperintense lesion along the right optic tract, extending inferiorly into the mesial right temporal lobe. This lesion measures 13 x 14 x 12 mm, compared to previous measurements of 12 x 12 x 13 mm, respectively. There is persistent enhancement, which is now increased in thickness peripherally. On the April 2015 exam, the lesion measured 9 x 12 x 7 mm, respectively.There is also a nonenhancing T2/FLAIR hyperintense and T1 hypointense lesion in the left optic chiasm/hypothalamus, measuring 11 x 12 mm in greatest axial dimensions, x 12 mm CC, compared to previous comparable measurements of 10 x 13 x 12 mm, respectively. This has not significantly changed since prior exam.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of new pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Smaller foci of T2/FLAIR hyperintensity along the more posterior portions of the bilateral optic tracts continue to appear similar.There is redemonstration of an oval peripherally enhancing right orbital segment optic nerve lesion with central cystic appearance, measuring up to 7 mm AP. Orbital structures are otherwise unremarkable. There is mild scattered mucosal thickening within the paranasal sinuses.
1. Slight increased thickness of rind of enhancement associated with right optic tract lesion extending into the mesial right temporal lobe, with slight increased size especially when compared to more remote exams. This is again concerning for progression of disease.2. Other presumed bilateral optic pathway gliomas are stable.