23-year-old with history of Li-fraumeni syndrome and anaplastic astrocytoma status post proton therapy. Interval follow-up exam. Stable postoperative changes from left parietal craniotomy and remote ependymoma resection. Resection cavity is CSF filled and appears to communicate with the atrium of the left lateral ventricle. The cystic focus anterior to the resection cavity related to recent biopsy with susceptibility artifact indicating postbiopsy hemorrhage.Compared to the prior MRI, there has been marked interval decrease in the extent of abnormal T2 signal within the white matter of the left parietal, temporal, and frontal lobes. The masslike thickening of the posterior corpus callosum has resolved. The previous abnormal increased T2 signal in the cingulate gyrus has also resolved. There remains mildly increased T2 signal crossing the splenium into the right parietal lobe as well as increased T1 and T2 signal extending into the left thalamus. A more nodular area of increased T2 signal in the subcortical white matter of the left inferior parietal lobule is not significantly changed.A cavernous malformation within the central pons is not significantly changed from prior. There are additional punctate foci of susceptibility artifact adjacent to the temporal resection cavity compatible with micro-hemorrhage.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. Unchanged right maxillary sinus mucous retention cyst. New near-complete opacification of the right sphenoid sinus. The visualized mastoid air cells are clear. The orbits are unremarkable.
1. Evidence of treatment response with significant interval decrease in masslike T2/flair hyperintensity involving the corpus callosum and left cingulate gyrus. There remains abnormally increased T2 signal centered in the periatrial region and inferior parietal lobule related to known tumor.2. Expected findings from recent left parietal biopsy. Also seen is a separate left parietal resection cavity related to prior ependymoma resection without findings to suggest ependymoma recurrence.3. No significant change in pontine cavernous malformation.4. Please note examination was performed without gadolinium due to severe renal insufficiency.