Diagnosis: Malignant neoplasm of other parts of brainClinical question: Eval for growth of glioma.Signs and Symptoms: low grade glioma. The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post right parietal craniotomy. The patient status post surgery along the right precuneus. There is signal change within the brain tissue surrounding the surgical site some of which extends and involves both gray and white matter at the right precuneus. When compared to the previous exam there is no interval change. There are punctate foci of susceptibility effect along the surgical site which were also present on the prior exam and have not changed to any significant degree. There is no associated contrast enhancement. On the perfusion scan there is a elevated rCBV on the non corrected scans within the resection cavity. There is redemonstration of an 8 mm FLAIR hyperintense lesion present along the left superior frontal gyrus along its medial aspect which remains stable compared to the prior exam. There is no associated contrast enhancement or susceptibility effectNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Status post right parietal lobe surgery. There is no significant change in the appearance of the adjacent brain parenchyma compared to prior exams. Low grade oligodendrogliomas may have paradoxically elevated rCBV.2.A left superior frontal gyrus lesion is stable compared to the prior exam.