Clinical question: History of major neuroblastoma status post craniotomy, chemotherapy and radiation therapy. Signs and symptoms: Off therapy evaluation. Pre and post enhanced brain MRI:Negative diffusion weighted images.Examination demonstrates a large focus of cystic encephalomalacia involving primarily the lateral aspect of the right cerebellum with resultant expansion of the cerebellar folia and the fourth ventricle. Post enhanced images demonstrate no detectable abnormal enhancement. Findings are similar to prior study from 2-13-15.Images through the supratentorial space demonstrate a subtle focus of FLAIR hyperintensity in the right coronal radiata without enhancement or interval change since prior study. Finding likely representing post treatment/radiation change.Mild prominence of cerebral cortical sulci for patient of stated age is noted. Post enhanced images demonstrate no detectable or abnormal enhancement of brain parenchyma or leptomeninges.Calvarium demonstrate postoperative changes of a right suboccipital craniotomy/craniectomy and unremarkable otherwise.Unremarkable images through the orbits including axial fat sat post enhanced series.
1.No acute intracranial process and no detectable new finding since prior exam.2.Right cerebellar encephalomalacia and resultant cerebellar parenchymal volume loss consistent with post surgical/treatment changes and without evidence of residual or recurrence of tumor.3.Stable small focus of nonenhancing FLAIR hyperintensity in the right coronal radiata likely representing posttreatment changes.4.Prominence of the supratentorial cortical sulci for patient's stated age as detailed and unremarkable exam otherwise.