Female, 56 years old, history of rate 3 meningioma, assess for growth versus radiation changes (biopsy proven radiation changes previously). Evidence of prior wide left pterional craniotomy is again seen. Patchy, largely gyriform enhancement with scattered susceptibility along the peripheral brain parenchyma subjacent to the craniotomy is redemonstrated showing no convincing or significant interval change. Enhancement involves the superior and middle frontal gyri as well as the operculum and insula. T2 hyperintensity in the surrounding parenchyma has also not significantly changed.Ill-defined enhancement conforming to the ependymal surface of the left frontal horn has progressed from the prior examination. In addition, one small linear focus of gyriform enhancement within the left temporal operculum (see image 94 series 21) is new. Scattered smaller enhancing areas within the left posterior and superior temporal lobe are unchanged.Within the left middle cranial fossa, a region of dural thickening seen on the prior examination has expanded into a more masslike lesion measuring up to 20 x 14 mm in the axial plane. This lesion extends both extracranially into the temporalis musculature and intracranially where it abuts and displaces the anterior temporal parenchyma. There is new edematous T2 signal within this compressed parenchyma. New from the prior examination is the development of heterogeneously enhancing masslike tissue centered within the left orbital apex measuring up to 28 x 17 mm in the axial plane and up to 14 mm in thickness in the coronal plane. This lesion extends both into the orbit where it effaces the orbital apex and likely compresses the optic nerve. It also seems to extend above the orbital roof with mild elevation of the left inferior frontal lobe but no definite parenchymal invasion or parenchymal edema. This abnormal tissue extends posteriorly to encase the anterior clinoid process and likely invades the left cavernous sinus to a mild degree. The ICA flow void remains visible throughout.
1.Redemonstration of postoperative findings compatible with prior meningioma resection from the left calvarium.2.Patchy gyriform enhancement and associated parenchymal T2 signal abnormality subjacent to the craniotomy, previously biopsied and found to represent radiation effect, shows no significant interval change.3.Enhancement along the ependymal surface of the left frontal horn has increased from the prior examination. As this enhancement is still rather ill-defined and is found in a radiation sensitive area, this likely represents progressive radiation effect as well. A new small linear area of gyriform enhancement within the superior left temporal lobe is also probably radiation related.4.Interval growth of a masslike intracranial and extracranial process centered along the left lateral middle cranial fossa is seen. This process abuts and displaces the adjacent anterior temporal parenchyma with evidence of parenchymal edema. These findings are concerning for recurrent tumor, with or without radiation effect.5.New growth of masslike soft tissue centered on the left orbital apex is also concerning for recurrent tumor. This lesion effaces the orbital apex with likely compression of the left optic nerve. It also extends posteriorly to encase the anterior clinoid process and likely invades the left cavernous sinus to a mild degree.