Clinical question: History of recurrent ganglioglioma status post craniotomy x5, radiation therapy and radiosurgery. Signs and symptoms: Off therapy 4:1/2 years. Pre- and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates extensive postoperative and treatment changes of the left mid and posterior temporal lobe without evidence of interval change since prior exam. There is mild expected dilatation of the trigone of left lateral ventricle similar to prior exam. Post enhanced images demonstrate no detectable abnormal enhancement which is a similar observation as prior exam and without evidence of recurrence of disease.Ventricular system is otherwise within normal and with maintained midline. The signal intensity of brain parenchyma otherwise within normal on all MRI sequences. Calvarium demonstrate expected postsurgical changes of left craniotomy.Pre- and post enhanced cervical MRI:There is normal signal intensity and alignment of vertebral column without evidence of enhancement.There is normal signal intensity and caliber of the cervical and upper most visualized thoracic cord and without abnormal enhancement.Foramen magnum is unremarkable areaC2-C3 is unremarkable.C3-C4 is unremarkable.C4-C5 demonstrate minimal degenerative changes and unremarkable otherwise.C5-C6 demonstrate mild degenerative changes with mild left neural foraminal compromise and unremarkable otherwise.C6/C7 demonstrate mild degenerative changes, shallow right median disc protrusion results in partial effacement of ventral subarachnoid space without central spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord to T3 level is unremarkable.
1.Stable post surgical/treatment changes of left temporal lobe without detectable residual or recurrence of tumor. Unremarkable pre and post enhanced brain MRI otherwise.2.Pre and postcontrast enhanced MRI of cervical spine demonstrate no abnormal osseous or meningeal enhancement. No evidence of central spinal stenosis. There is however mild degenerative changes of spine and including a small right paramedian disc protrusion at C6/C7 as detailed. Please see detailed report per level above. Incidental note is made of a mass measuring 31 x 28 mm in transaxial dimension, likely representing an enlarged right lobe of thyroid. Follow-up with ultrasound is recommended.