Anaplastic astrocytoma status post chemotherapy and radiation treatment. Headache and increasing weakness. Again seen are areas of intrinsic T1 shortening as well as heterogeneous nodular enhancement in the right frontal, parietal, and temporal lobes predominantly in the periventricular regions related to known tumor. Enhancement extending across the corpus callosum is again seen including at the levels of genu, body, and splenium. Enhancing nodules in the left frontal lobe are stable to minimally larger. For example the more anterior enhancing left frontal lobe nodule measures up to 6 x 9 x 10 mm, previously previously 6 x 7 x 9 mm. Subtle differences in measurement may relate to contrast timing and technique with the current study performed at 3 Tesla and previously at 1.5 Tesla. Restricted diffusion is again noted in these areas. Extensive masslike FLAIR signal abnormality in the right cerebral hemisphere extending across the corpus callosum into the left cerebral hemisphere as well as extending inferiorly into the brainstem is again seen and not significantly changed since 10/7/2016. Mass effect with partial effacement of the lateral ventricles is not significantly changed. No significant change in size of the ventricles. There is no significant midline shift or uncal herniation. Compared to 7/29/2016, areas of enhancement and masslike FLAIR signal abnormality are clearly progressed however.Prior postsurgical changes including right temporoparietal craniotomy and right anterior parietal burr hole again seen. A focus of susceptibility along the right precentral gyrus likely represents a biopsy marker. Hemosiderin deposition the surgical bed is similar to prior examination. No findings to suggest acute ischemia, new hemorrhage or new mass effect. Mild to moderate mucosal thickening involving the anterior ethmoid air cells and frontal sinuses is similar to prior.
Allowing for slight differences in technique, there is no significant change since 10/7/2016. Compared to 7/29/2016, however, there appears to have been significant progression with increased tumor involvement of the right frontal lobe, corpus callosum, and extension into the left cerebral hemisphere. 