53 years Male (DOB:8/17/1962)Reason: evaluate stage of disease History: anaplastic large cell lymphoma with brain metastasisPROVIDER/ATTENDING NAME: GREG TOMCZYK SONALI M SMITH There is a nonenhancing heterogeneous lesion present in the right cingulate gyrus and adjacent to right paracentral lobule associated with the foci of susceptibility effect and local volume loss. It is associated with some foci of T1 signal hyperintensity. Axial dimensions of the FLAIR signal abnormality are approximately 54 x 28 mm axial dimensions. On coronal T2 imaging measures approximately 34 x 27 mm coronal dimensions. This is stable since 4/11/2016.Another nonenhancing heterogeneous lesion is present in the right basal ganglia which measures 20 x 16 mm axial dimensions. This was larger on the prior exam. It is associated with some foci of T1 signal hyperintensityThere is a nonenhancing 3 mm T2 hyperintense lesion associated with susceptibility effect located in the left caudate nucleus which remains stable compared to the prior exam. It is associated with T1 signal hyperintensity.A small focus of susceptibility effect is present along the left occipital lobe lingual gyrus adjacent to the calcarine sulcus anteriorly. It is stable compared to the prior exam.A punctate focus of T2 and FLAIR hyperintensity is present in the right thalamus stable. It is associated with susceptibility effect.FLAIR signal hyperintensity at the temporal lobe is suspected to represent artifact as it is not seen on the T2 imaging studies.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Some of the images are degraded due to patient motion as well as by motion. Many of the imaging sequences were repeated.
1.Since the previous examination a lesion located in the right basal ganglia has regressed in overall size.2.Small lesions in the left caudate nucleus, right thalamus and the left occipital lobe as well as a larger lesion centered in the right cingulate gyrus are stable .3.Although no cranial nerve lesion is identified contrast-enhanced MRI exams or more sensitive in identifying cranial nerve lesions when compared to noncontrast exams.