 MRI brain: There is no evidence of discernible mass in the visualized portions of the nasopharynx. There is redemonstration of heterogeneous marrow signal involving the central skull base including clivus with ill-defined enhancement which extends along bilateral left more than the right expanded pterygopalatine fossa, unchanged from the prior exam. There is mild diffuse enhancement extending to the right more than the left masticator space, grossly similar to prior exam. There is no new enhancement in the nasopharynx.There are scattered patchy foci of T2/FLAIR signal throughout the cerebral white matter which are nonspecific, most likely representing mild chronic small vessel disease, unchanged. There is a small focus of T2/FLAIR hyperintense lesion involving the left cingulate gyrus with associated punctate focus of susceptibility which may represent prior ischemic injury and associated chronic hemosiderin deposition, unchanged.There is an ill-defined apparent focus of enhancement along the right paramedian genu of the corpus callosum seen only on the coronal post contrast images of the brain (series 20, image 19), which was also suggested on coronal post-contrast images on the prior exam, however, not demonstrated on any other post-contrast sequences including post axial 3-D T1 weighted imaging and coronal postcontrast images through the orbits (although these are not as delayed). Hence this focus of enhancement is favored to be artifactual. Otherwise, there is no evidence of parenchymal enhancement or meningeal enhancement.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is no diffusion abnormality. 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. There is unchanged opacification of the anterior and posterior ethmoid air cells as well as mucosal thickening in the bilateral maxillary sinuses, similar to the prior exam. There are stable diffuse opacification of the bilateral mastoid air cells, similar to prior.MRI ORBITS: There is mild nonspecific non-mass-like enhancement in the right orbital apex corresponding to the site of previous tumor, unchanged from prior. Previously demonstrated intraorbital extension of tumor with mass effect on the medial rectus and right optic canal is completely resolved. No definite abnormal mass or abnormal enhancement is seen in the intraconal or extraconal compartment. No abnormal enhancement along the foramen rotundum or inferior orbital fissure. The optic nerves are normal in size and signal intensity, and are symmetric bilaterally. No retrobulbar mass, chiasmatic mass, or parasellar abnormality is seen. Extraocular muscles are unremarkable.
1. Stable posttreatment changes related to treated nasopharyngeal carcinoma with ill-defined enhancement involving the base of skull as well as pterygopalatine fossa extending to the right more than the left maxillary space without significant interval change compared to the prior exam. No evidence of tumor recurrence.2. Ill-defined apparent punctate focus of enhancement along the right paramedian genu of corpus callosum, which was not present on any other sequences, with similar focus of enhancement present on same sequence on the previous exam is felt to be artifactual. Attention on follow-up exam.3. No evidence of intraorbital mass or tumor extension.4. Scattered cerebral white matter T2/FLAIR hyperintense foci, may relate to chronic small vessel ischemic changes, similar to prior.5. Stable extensive opacification of the bilateral ethmoid air cells and bilateral maxillary sinuses as well as opacification of the bilateral mastoid air cells.