Grade 2 left medial temporal lobe astrocytoma status post radiation. Seizures. Compared to 8/30/2014, there is slight increase in masslike T2/FLAIR hyperintensity and cortical thickening involving the anterior and medial left temporal lobe, the left insular cortex and the posterior left thalamus. Much of this increase appears to involve the subcortical white matter of the left temporal lobe and left parietal periatrial white matter, favored to be related to posttreatment change. There is mild restricted diffusion involving the posterior aspect of the left parahippocampal gyrus which may be related to hypercellularity. There are subcentimeter foci of enhancement involving the left subinsular white matter and left medial temporal lobe which appear new. No hydrocephalus or extra-axial fluid collections. No midline shift or herniation. There is evidence of left transfrontal biopsy. Multiple foci of susceptibility are again noted compatible with chronic microhemorrhage consistent with hemosiderin deposition. Chronic blood products are also noted along the tract of the left transfrontal biopsy which extends to the left medial temporal lobe. Lipomatous lesion is again seen involving the posterior aspect of the left parotid gland. The skull and extracranial soft tissues are otherwise unremarkable.
Compared to 8/30/2014, there is slight increase in T2/FLAIR hyperintensity involving the anterior and medial left temporal lobe, left insular cortex and left thalamus. Much of the mild increase appears to involve the subcortical white matter. There are also new foci of enhancement involving the left subinsular white matter and left medial temporal lobe. Given history of recent radiation, these findings are favored to reflect post treatment changes and can be further assessed on follow-up studies.