 The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is a similar extent but slight increased confluence of patchy T2 and FLAIR hyperintensity within the deep white matter bilaterally, with involvement of the external capsules. This is progressed since the prior MRI from June 2015. A more asymmetric area persists along the posterior limb of the left internal capsule extending into the corona radiata. There are no areas of pathological enhancement. The previously questioned punctate subtle focus of apparent enhancement in the left medial temporal lobe is no longer appreciated, consistent with prior artifact. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
1.No abnormal enhancement to suggest recurrent metastatic disease. Previously questioned punctate focus in the left temporal lobe was artifactual in etiology.2.Slight further increased confluence of abnormal signal throughout the deep white matter in a symmetric pattern which is nonspecific but felt to be posttreatment related, increased since June 2015.