56 years, Male, Reason: Eval multifocal AA. pt on CCNU+Avastin. Again seen are multiple masslike areas of T2/FLAIR hyperintensity, some of which demonstrate enhancement and compatible with known multifocal glioma. Compared to 2/10/2016 the right posterior superior frontal gyrus lesion has enlarged, previously 1.4 x 1.5 cm on the post gadolinium images now approximately 2.7 x 2.8 cm in the AP and transverse dimensions. There is associated restricted diffusion. There is decrease in the previously seen solid enhancement which may reflect Avastin effect.  Mass like T2/FLAIR hyperintensity involving the left frontoparietal corona radiata is not significantly changed. No associated enhancement.Left thalamic lesion with intrinsic T1 hyperintensity, susceptibility related to blood products, and perhaps minimal enhancement is stable to minimally decreased in conspicuity.Multiple foci of enhancement and FLAIR hyperintensity in the left posterior temporal lobe including adjacent to the left occipital horn are again seen some of which are not significantly changed. There is a relatively larger area of heterogeneous enhancement in the left posterior temporal lobe (series 1101 image 14) which is stable to minimally larger than immediate prior but smaller when compared to prior study from 11/6/2015. There is susceptibility effect which is slightly more prominent than prior and may represent increasing blood products and/or mineralization. There is an enhancing left temporal-occipital lesion, series 1101 image 12 which measures 9 x 9 mm previously 6 x 7 mm. There is also a punctate enhancing lesion just inferior to it, series 1101 image 11, which also appears increased in conspicuity. Surrounding FLAIR hyperintensity is not significantly changed. Enhancement involving the left insular cortex with FLAIR hyperintensity is not significantly changed.No midline shift or herniation. No hydrocephalus. Major flow-voids are preserved.
Again seen is evidence of multifocal glial neoplasm as described above most of which are not significantly changed since 2/10/2016. There is however a notable right posterior frontal lobe mass which demonstrates relatively rapid enlargement when compared to prior studies from 12/30/2015 and 2/10/2016. There is relatively mild peripheral enhancement which is likely related to Avastin effect. Please see additional details above regarding additional lesions which are slightly larger.