59 years, Female, primary CNS lymphoma, status post cycle 1 induction chemotherapy. There are bilateral frontal burr holes related to biopsies. There are subacute blood products in the left frontal lobe which have decreased since prior CT from 9/15/2016. There is intrinsic T1 shortening and mild residual enhancement in the left frontal lobe, which is markedly decreased when compared to prior MRI from 9/12/2016. T2/FLAIR hyperintensity related to vasogenic edema in the left frontal lobe is also significantly improved. Residual enhancement is most evident involving the left anterior cingulate gyrus. Associated mass effect has also significantly improved with reexpansion of the lateral ventricles.T1 shortening with questionable enhancement and surrounding T2 hyperintensity involving the right thalamus and right frontal lobe are again seen with much larger lesions in these locations evident on earlier MRI from 5/1/2016. No new enhancement or new intracranial mass is seen to suggest disease progression. There is moderate degree of T2/FLAIR hyperintensity in the pons similar to prior MRI from 9/12/2016 and is nonspecific; finding reflect chronic small vessel ischemic disease, posttreatment change, or prior osmotic demyelination.No evidence of acute ischemia. No significant intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. Major flow-voids are preserved. Moderate opacification of the left-sided mastoid air cells is again seen.
Marked interval decrease in size of enhancing mass in the left frontal lobe consistent with treatment response. There is mild residual enhancement in the left frontal lobe along the left anterior cingulate gyrus, which is best seen on the post gadolinium 3-D T1 sequence. Questionable, minimal enhancement is present in the right frontal lobe and right thalamus at the sites of much larger masses seen on earlier MRI study from 5/1/2016. No new or enlarging lesions compared to 9/12/2016.