Grade III astrocytoma status post RT/TMZ and 12 cycles of TMZ. Currently off all treatment. A curvilinear area of T2 hyperintensity within the left paramedian precentral gyrus has increased in size compared to the previous exam where it now measures 6 x 13 mm (series 11, image 6), compared to 2 x 6 mm previously.A new predominantly ring-enhancing lesion is visualized within the middle left temporal gyrus which measures 16 x 13 mm (series 11, image 20). This lesion was not distinctly visualized previously.The T2 hyperintense lesion within the left thalamus shows no significant interval change in size or morphology over multiple prior examinations. A biopsy marker remains evident in the center of the lesion. The lesion demonstrates intrinsic T1 hyperintensity with little if any true superimposed enhancement.A subcentimeter enhancing focus along the margin of the left occipital horn may be slightly larger in size compared to the previous exam.Ill-defined periventricular white matter T2 hyperintensity along the left lateral ventricle is stable when compared to the immediate prior examination, but shows slight expansion in geographic extent when compared to older exams. Some of this signal abnormality was evident on the patient's initial pretreatment studies.Numerous additional scattered small foci of T2 signal abnormality are seen throughout both cerebral hemispheres, without significant or convincing interval change. No new mass effect or parenchymal edema is detected. Ventricles are stable in size including mild ex vacuo dilatation of the left lateral ventricle.
1.Interval increase in size of the left paramedian precentral gyrus enhancing lesion and possible increase in size of the lesion adjacent to the left occipital horn compared to the previous exam, suspicious for growing tumor.2.Interval development of a new left middle temporal gyrus ring-enhancing lesion, suspicious for new tumor that was not discretely seen previously.3.Stable appearance of the treated lesion involving the left thalamus.4.Ill-defined left periventricular white matter T2 hyperintensity is stable relative to the previous two examinations.