History of primary CNS lymphoma status post 4 cycles of MTR. There are postoperative findings related to transfrontal biopsy, including extra-axial T1 hyperintensity and susceptibility compatible with chronic blood products. There is interval decrease in size of patchy areas of high T2 signal in the left periventricular white matter. There are otherwise unchanged scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter. There is no evidence of intracranial hemorrhage or acute infarct. The midline structures and craniocervical junction are within normal limits. There is global parenchymal volume loss. Otherwise, the ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are unchanged.
Numerous scattered nonspecific punctate foci of T2 hyperintensity in the cerebral white matter may represent chronic small vessel ischemic disease. Otherwise, left periventricular signal abnormality at the site of the treated CNS lymphoma has subsided, although assessment is limited by the lack of intravenous contrast.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.