 There are enhancing lesions in the right frontal and temporal lobes with an additional thin, tract-like region of enhancement extending between them (which was not previously visualized). There are areas of restricted diffusion associated with the 2 largest lesions. When compared to the prior study, the lesions demonstrate increase in enhancement, regional mass effect, and surrounding T2 hyperintensity, compatible with edema. The temporal lobe lesion currently measures 3 x 2.8 cm in the axial plane, which previously only demonstrated non mass-like enhancement. The frontal lobe lesion has been surgically decompressed in the interim, but still demonstrates marked peripheral enhancement and has increased in size, measuring 4.2 x 2.7 cm, previously 3.2 x 2.1 cm. The enhancing tissue correlates to elevated rCBV.T2 hyperintensity and thickening without enhancement in the left frontal and parietal lobes is grossly stable when compared to the most immediate prior study, but has increased when compared to older exams.There are expected postsurgical findings related to right frontal and temporoparietal craniotomies with previous partial tumor resection. There is associated dural thickening and enhancement, which is likely postsurgical.The ventricles and sulci remain patent. There is no significant midline shift. No large extra-axial collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. The orbits are intact.
1.Multiple enhancing lesions in the right cerebral hemisphere which demonstrate enlargement when compared to the prior outside study from 12/10/15. The appearance on conventional MRI and rCBV mapping favors progression of disease.2.There is also T2 hyperintense thickening suspected to represent nonenhancing tumor in the left frontal and parietal regions which appears grossly similar to the most recent prior, but has increased over time.