Left temporal/insular anaplastic astrocytoma, status post surgery, radiation therapy/TMZ and 12 cycles of TMZ. There is a new punctate focus of diffusion hyperintensity in the left parietal subcortical white matter with associated FLAIR hyperintensity and mild enhancement. Redemonstrated is nonenhancing high T2 signal abnormality with gyral thickening in the left medial and anterior temporal lobe, amygdala and insular cortex. There is no new mass effect. There is an unchanged left thalamic developmental venous anomaly and adjacent T1 shortening and enhancement. The ventricles and basal cisterns are unchanged. There is no midline shift or herniation. The imaged paranasal sinuses and mastoid air cells are clear. There is diffuse low T1 marrow signal in the calvarium which is unchanged.
1. Stable lesion in the left medial anterior temporal lobe and insular cortex without evidence of tumor progression.2. New punctate focus of diffusion hyperintensity in the left parietal subcortical white matter with associated FLAIR hyperintensity and enhancement likely representing a tiny subacute infarct. Findings conveyed to Dr. Lukas by EPIC mail at the time of dictation.