Female, 53 years old, with altered mental status, plasma cell leukemia, previous lesions. Evaluate hippocampal lesion and compare size of previous lesions. The previously demonstrated left frontal dural based enhancing lesion has significantly regressed when compared to prior examinations, particularly the exam of 06/15/16. There is no longer any detectable enhancement in this area. The parenchyma which had previously been compressed now shows ill-defined T2 hyperintensity. A small area of extra-axial susceptibility at the site of the prior lesion likely represents hemosiderin staining.Multiple additional smaller dural based enhancing lesions which were evident bilaterally are no longer clearly appreciated. The marrow of the calvarium remains heterogeneously enhancing but there are no longer any extraosseous masslike lesions.Periventricular T2 hyperintensity along the right frontal horn is unchanged relative to the immediate prior examination but has progressed compared to the older study. A few additional punctate foci of FLAIR hyperintensity in the cerebral hemispheres are nonspecific and not significantly changed. No evidence of any hippocampal lesion is seen. No new enhancing lesions are seen. No abnormal extra-axial fluid collections are detected. The ventricular system is normal in size and morphology.The previously demonstrated lesion centered on the right maxillary sinus floor with invasion of the buccal and masticator spaces is partially visualized and does not appear to have changed significantly.
1.Significant decrease in the size of the previously seen large extra-axial enhancing mass in the left frontal region. A small area of extra-axial hemosiderin staining is seen but no residual pathologic enhancement is detected. T2 hyperintensity within the adjacent frontal parenchyma may represent mild residual edema or gliosis.2.Multiple smaller extra-axial enhancing lesions have also resolved with no residual or new pathologic intracranial enhancement. The marrow of the skull, however, continues to demonstrate heterogeneous enhancement.3.No new intracranial lesions are seen. No specific evidence of any hippocampal lesion is detected.4.The partially visualized lesion involving the right maxillary sinus, buccal space and masticator space does not appear to have significantly changed.