Diagnosis: Neoplasm of unspecified nature of brain Malignant neoplasm of brain, unspecified siteClinical question: Eval for growth of high-risk low grade glioma on TMZ.Signs and Symptoms: astrocytoma.Comments: High-risk low grade astrocytoma. S/p RT/TMZ and now on TMZ. | The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left frontal burr hole placement a track of susceptibility effect can be course from the burr hole to the left thalamic lesion suggesting this could be related to prior stereotactic biopsy.There is a left posterior thalamic lesion present with T1 hyperintensity and a focus of susceptibility effect which is stable in appearance when compared to the previous exam.There is a nonenhancing focus present in the left centrum semiovale T2 and FLAIR signal hyperintensity which is stable compared to the prior exam.A small lesion in the left temporal lobe subcortical white matter associated with contrast enhancement and susceptibility artifact measuring 6 mm in size is unchanged since the prior exam.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.
Compared to the prior exam is no significant interval change in the patients left thalamic, left centrum semiovale lesions in the left periventricular white matter lesions.