Clinical question: Baseline MRI prior to starting systemic chemotherapy treatment. Compared to study from 3 -- 5 -- 15. Signs and symptoms: Pre-and post-enhanced brain MRI:Examination demonstrate postoperative changes of a large right cerebellar resection. The CSF signal intensity surgical cavity without interval change in size is again noted. There is a very thin partial rim enhancement of the surgical cavity without convincing evidence of tumor residual or recurrence with interval improvement since prior study.Supratentorially examination demonstrate significant interval increase in parenchymal and leptomeningeal enhancement extending from left anterior temporal posteriorly at the site of previously resected tumor and highly concerning for recurrence. A very faint focus of enhancement at the site superficially in the left anterior temporal which measured 9 times 10-mm in size demonstrate significant interval increased size in an irregular fashion. There is also or increased ventricular thick rim enhancement of the left posterior temporal surgical cavity. In addition a new single parenchymal focus of enhancement in the periventricular white matter of left trigone of lateral ventricle (axial post enhanced series 1501 image 17) is concerning for new metastatic lesion. This finding measures approximately 5.9 x 6.5-mm and demonstrate restriction on diffusion weighted series.Expected postoperative changes of a large left frontal temporal craniotomy with mild epidural thickening under the craniotomy flap and with expected dural thickening and enhancement.
1.Significant interval increase enhancement of parenchyma and the leptomeninges in the left anterior and mid temporal lobe as well as surrounding the left temporal surgical cavity concerning for progression of disease. New small focus of enhancement in the periventricular white matter left trigone as mentioned above.2.Stable post operative changes right cerebellar without evidence of residual or recurrence.3.Stable dilated left lateral ventricle and mildly prominent right lateral ventricle with maintained midline.4.Expected postoperative changes of larger left frontal -- temporal craniotomy as detailed.