 There is no evidence of diffusion restriction. No abnormalities are visualized in the susceptibility images.High signal on T2 and FLAIR with low signal on the T1 images and no concerning enhancement is seen in the right frontal region, representing postsurgical changes with encephalomalacia, with no significant changes since the previous study..The two foci of slight high signal on FLAIR and enhancement that were seen in the previous study in the right superior temporal gyrus are still visualized. The most lateral lesion is increased in size from 8 x 5 mm in the previous study to 9 x 6 mm currently. The dominant medial lesion is unchanged in size since the previous study and measures 6 x 5 mm. Two punctate foci of increased enhancement are seen anterior to the medial lesion, with one appearing stable and the other more anterior one not definitely seen previously.In addition, a new enhancing lesion is seen in the right temporal lobe posteriorly in between the 2 previous larger nodular lesions. This lesion measures 6 x 5 mm, with associated new FLAIR hyperintensity.Ventricular size is normal with no evidence of mass effect or bleed. Basal cisterns remain patent. No evidence of acute infarction. No evidence of herniation. There is no midline shift. No evidence of extra-axial fluid collection.There is a globular structure in the upper left maxillary sinus which again demonstrates high signal on T1, T2, and FLAIR with signal loss in fat suppression images. There is an associated orbital floor defect is seen. This represents orbital fat herniation into the left maxillary sinus from a chronic orbital floor fracture.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Please note that MR perfusion imaging could not be post processed due to technical error at this time.
1. No changes in the surgical cavity of the right frontal lobe since the previous study.2. The two enhancing lesions that were seen in the previous study in the right superior temporal gyrus are still visualized. The lateral lesion is slightly increased in size. New adjacent punctate enhancing lesions noted, concerning for tumor progression versus posttreatment change. Continued follow-up is again recommended.