Multifocal low-grade gliomas. The patient was initially diagnosed with a right frontal grade 2 oligodendroglioma which was treated with RT and then subsequently developed a cerebellar/brainstem oligoastrocytoma, which was also treated with RT in 2009. There are postoperative findings related to a right frontal craniotomy with unchanged confluent signal abnormality involving the right anterior frontal lobe, corpus callosum, insula, and right cingulate gyrus. There is cortical thickening and T2 hyperintensity extending posteriorly along the right cingulate gyrus, which is unchanged. A very small area of gyral thickening and signal abnormality within the right precentral gyrus has slowly been progressing since 2013 but is only minimally changed from a prior 2014 study (image 26, series 6). There are unchanged foci of high T2 signal within the left cerebellar hemisphere. A punctate focus of apparent enhancement along the posterior resection cavity correlates with a vessel, which is better seen on a prior study. There is no pathologic enhancement. There is no evidence of acute intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration, with ex-vacuo dilatation of the right lateral ventricle. There is no midline shift or herniation. The skull and extracranial soft tissues are unchanged.
1. Overall, no significant changes in signal abnormality surrounding the right frontal lobe resection cavity or the left cerebellar hemisphere.2. Small area of cortical thickening and signal abnormality in the right precentral gyrus has been slowly developing over the last two years, but in the near term, only minimal progression is seen. 