Clinical question: Brain tumor. Signs and symptoms: Brain tumor. Pre-and post-enhanced brain MRI:Examination redemonstrate previously known cluster of extra axial dural based rim enhancing lesion in the left subfrontal and left anterior middle cranial fossa at the site of previous meningioma resection. Compared to prior exam there is noticeable interval decreased size of this finding which is highly suggestive of postoperative change and likely loculated hemorrhage. The focus of rim enhancement in the left subfrontal region measures at 10 x 14-mm in size compared to prior study measurement of 14.5 x 18.5-mm.The largest focus of enhancement along the anterior left middle cranial fossa measures at approximately 12.5 x 21 mm compared to prior study measurement of 14 x 26.Additional well-demarcated focus of rim enhancement in the left anterior middle cranial fossa measures at 7.3 x 7-mm compared to prior study measurement of 11.5 x 11.6mm. The findings in left anterior up fossa and left subfrontal region are highly suggestive of postoperative change and very unlikely to represent tumor.Flair hyperintensity of the left anterior temporal lobe demonstrate interval decreased size and extent and consistent with gliosis.There is no convincing evidence of residual or recurrence of tumor however further follow-up is recommended considering presence of residual postoperative enhancement which could obscure small tumor recurrence. There is a tiny focus of nonspecific flair hyperintensity in the cingulate gyrus of the right frontal lobe is again identified and without change.
1.Internal improvement with decreased size of cluster of extra axial rim enhancing lesions in the left anterior middle cranial fossa and left subfrontal region consistent with postsurgical change as detailed/measured above.2.Interval decrease left anterior temporal tip flair hyperintensity suggesting improvement of residual vasogenic edema at the surgical site.3.Stable tiny focus of nonspecific flair hyperintensity in the right frontal single he gyrus and with minimal enhancement.