High risk low grade astrocytoma, evaluate for progression. Status post biopsy and RT/TMZ. Again seen is sequela of left frontal approach biopsy. Again seen is a nonenhancing T2 hyperintense mass involving the left thalamus measuring approximately 3.8x2.6x3.0 cm in the AP, transverse, and craniocaudal dimensions. The lesion has not significantly changed in size from prior exams. Also unchanged is T2 hyperintensity and thickening involving the left amygdala and medial temporal lobe which likely represents infiltrative tumor as well. Linear branching enhancement within the left thalamus appears vascular and more apparent perhaps due to treatment change.A few scattered foci of T2 hyperintensity are evident elsewhere in the cerebral white matter which are nonspecific and unchanged. No restricted diffusion is seen. No new lesions are detected. No evidence of intracranial hemorrhage is seen apart from minimal susceptibility along the biopsy tract. No pathologic fluid collections are detected. The ventricular system is stable in size and morphology including minimal effacement of the left lateral and third ventricles secondary to mass effect related to the tumor.
Compared to 11/4/2014 and 8/27/2014, there is no significant interval change in the size of left thalamic tumor. Also unchanged is evidence of tumor extension into the medial aspect of the left anterior temporal lobe. There is linear branching enhancement within the posterior aspect of the left thalamic tumor, which is favored to be vascular.