 Brain: There is no discrete residual mass in the nasopharynx. There remains heterogeneous marrow signal involving the central skull base and ill-defined enhancement involving the bilateral pterygopalatine fossa and masticator spaces. There is diffuse opacification involving the bilateral anterior and posterior ethmoid air cells and to a lesser degree bilateral maxillary sinuses which is slightly improved in the interval and likely related to inflammatory mucosal thickening. There is diffuse opacification of the bilateral mastoid air cells which was present previously. There remains unchanged nonspecific patchy foci of T2 hyperintensity throughout the supratentorial white matter most likely representing mild chronic small vessel disease. Again seen is a small focus of cortical FLAIR hyperintensity and volume loss involving the left cingulate gyrus with foci of susceptibility which may be related to prior ischemic injury with hemorrhage and unchanged. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids remain intact. No abnormal parenchymal or meningeal enhancement in the brain.Orbits: Intraorbital extension of the tumor has resolved bilaterally when compared to the initial presentation MRI, and unchanged when compared to the more recent MRI. Bilateral globes and intraconal contents including optic nerves are unremarkable.
Posttreatment changes related to nasopharyngeal cancer without definite evidence of residual tumor. There remains heterogeneous enhancement involving the central skull base as well as the pterygopalatine fossa without corresponding abnormal FDG uptake on prior PET/CT and compatible with treated tumor.