 There is redemonstration of T2/FLAIR hyperintensity involving the mildly expanded right cerebral peduncle and right greater than left ventral pons, similar in distribution to the most recent MRI fusion exam. An additional rounded area of slightly heterogeneous T2 hyperintense signal is present, centered in the lateral aspect of the right thalamus extending into the right posterior basal ganglia. There are foci of central susceptibility in this lesion in addition to a linear tract of susceptibility extending anteriorly from the lesion towards the right frontal burr hole, consistent with recent biopsy tract and probable associated chronic blood products. This lesion measures 1.7 x 1.6 cm on 701/20, compared to previous 1.4 x 1.4 cm. There is minimal patchy intrinsic T1 hyperintensity within the lesion with mild superimposed enhancement along superior posterior aspect in a nodular configuration on 1101/23. This enhancing nodule now measures 8 x 9 mm compared to previous 6 x 6 mm.In the area of the ring-enhancing lesion in the left anterior parietal subcortical white matter, there is now an irregularly shaped somewhat bilobed appearing structure with peripheral enhancement, now measuring at least 2.9 x 1.8 cm in greatest axial dimensions, previously measuring overall 1.6 x 0.8 cm. There is also progressive surrounding T2/FLAIR hyperintensity in this area. A teardrop shaped CSF signal intensity resection cavity is identified anteriorly and superiorly, without significant interval change.Perfusion imaging demonstrates relative hypoperfusion in areas of above described abnormal signal and enhancement except for mild peripheral hyperperfusion along the rounded right thalamic/basal ganglia mass.There is persistent ill-defined T2/FLAIR hyperintensity involving the left paramedian posterior frontal gyri white matter with minimal ill-defined linear enhancement on delayed post contrast images. There is questioned additional nonspecific gyral thickening and FLAIR hyperintensity involving the right greater than left mesial temporal lobes with extension into the right hippocampus and right paramedian occipital lobe cortex, although components of this could be artifactual.The ventricles and sulci are stable, with ex vacuo dilatation of the left lateral ventricle. The cisterns remain patent. There is no midline shift or mass effect. The above scattered focal masses demonstrate associated diffusion restriction suggestive of hypercellular tumor, although there is no area of diffusion restriction suggesting acute 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.
1.Slight interval increased size of right posterior thalamic/basal ganglia heterogeneously enhancing mass status post biopsy with associated likely postoperative blood products. Mild hyperperfusion noted peripherally.2.No significant interval change in appearance of expansile right cerebral peduncle/right greater than left pontine mass.3.Interval increased size of now bilobed appearing peripherally enhancing left anterior parietal lobe white matter lesion with increased extent surrounding nonspecific nonenhancing T2/FLAIR hyperintensity, which may represent a combination of tumor progression and/or posttreatment effects.4.Persistent gyral thickening and abnormal signal with minimal enhancement along the left paramedian posterior frontal lobe gyri, with additional apparent questioned nonspecific right greater than left mesial temporal lobe FLAIR hyperintense gyral thickening and right occipital lobe cortical FLAIR hyperintensity. Continued follow-up is requested.