 There has been interval expected evolution of previously seen immediate postoperative changes from right parietal craniotomy for biopsy of right posterior and medial temporal lobe multifocal mass. Since the prior preoperative MRI, there has been interval further progression of multiple sites of enhancing tumor. For example, there is an oval satellite lesion anterolateral to the dominant mass which measures 8 x 12 mm on 1201/82, compared to previous 5 x 6 mm. The dominant component of the solid and cystic mass measures 3.9 cm transverse x 4.1 cm AP, and 4.4 cm CC, compared to previous measurements of 3.8 x 3.8 cm axially. There is overall increased cystic component of the dominant portion of the mass. There is likely interval slight progression of tumor involvement of the splenium of the right corpus callosum, which is now increasingly thickened with T2/FLAIR hyperintensity which now minimally crosses midline on 701/18.There are small areas of lobulated intrinsic T1 hyperintensity peripherally in the right posterior temporal lobe underlying the craniotomy site with corresponding susceptibility, consistent with blood products. Of note, there are small blood-fluid levels in the area of the most peripheral biopsy site, with increased associated nodular enhancement. Additional lobulated areas of intrinsic T1 hyperintensity within the dominant portion of the lesion not present on the prior precontrast T1-weighted images may represent a combination of proteinaceous material and/or blood products. There is additional slightly more remote ill-defined enhancement along the peripheral right parietal lobe as seen on 1201/110 which appears perhaps slightly increased in conspicuity and extent. There is slight increased thickening of masslike FLAIR hyperintensity in the right parietal periventricular and deep white matter. Right optic tract is difficult to delineate and may be minimally thickened on coronal T2-weighted images.Midline shift is similar, measuring 7 mm to the left. There is also localized mass effect, predominantly on the right lateral ventricle, with again focal dilatation of the right temporal horn which appear similar in degree. The lateral ventricles are overall moderately dilated. There is again extension of the mass into the right midbrain with distortion of surrounding architecture, including anteromedial displacement of the red nucleus and substantia nigra. FLAIR hyperintensity continues to extend into the posterior aspect of the external capsule and the posterior limb of the right internal capsule. Allowing for differences in technique, there is overall similar extent of FLAIR abnormality in the right temporal lobe white matter. There are few nonspecific punctate foci of FLAIR hyperintensity in the left subcortical and periventricular white matter which appear mostly unchanged. There remains diffuse right cerebral sulcal effacement, as well as diffuse right temporal cortical FLAIR hyperintensity and gyral thickening.There is no diffusion abnormality to suggest recent ischemia. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. MR perfusion demonstrates elevated rCBV in the area of enhancing mass, especially in the area of more confluent enhancing soft tissue, cranial to the dominant cystic components, consistent with known high-grade glioma.
1.Interval expected evolution of previously seen postoperative changes following lesion biopsy, with overall progression of heterogeneously enhancing solid and cystic right temporal lobe mass extending to the midbrain with multiple adjacent satellite lesions which have also worsened. This is consistent with tumor progression. However, similar degree of midline shift and localized mass effect.2.Likely interval slight progression of presumed tumor involvement of the splenium of the right corpus callosum with increased thickening and minimal midline crossing of abnormal signal.3.Areas of interval increased T1 signal within components of the mass likely relating to areas of proteinaceous material and/or blood products.4.Similar degree of right temporal horn dilatation likely relating to trapping by the tumor, with otherwise more symmetric moderate prominence of the lateral ventricles.5.Similar degree of nonenhancing areas of FLAIR hyperintensity within predominantly the right temporal lobe white matter as well as extending minimally into the right internal/external capsules. These are nonspecific and may relate to a combination of nonenhancing tumor and/or vasogenic edema.