 Again seen is resection cavity in the right temporal lobe. Most of the surrounding FLAIR hyperintensity in the right temporal lobe is not significantly changed. There is however slight increase in FLAIR hyperintensity and more prominent increase in nodular enhancement which demonstrates restricted diffusion along the medial aspect of the resection cavity. This area of enhancement abuts the lateral ventricle. Perfusion images demonstrate no clear elevation in cerebral blood volumes in the regions with new enhancement.The ventricular system remains mildly enlarged but unchanged. Mild periventricular T2/FLAIR hyperintensity as well as additional scattered nonspecific foci of T2/FLAIR are not significantly changed. The right temporoparietal craniotomy flap with small underlying extra-axial fluid collection remains unchanged. No associated mass effect. No evidence of midline shift or herniation.
Compared to the previous examination of 9/16/2015, there is increase in nodular enhancement along the medial aspect of the right temporal resection cavity, slight increase in associated FLAIR hyperintensity, and restricted diffusion. No clear elevated CBV in these regions is demonstrated although volume averaging and relatively small areas of new enhancement makes assessment on the perfusion sequence limited. As such, findings may be related to recent re-irradiation although early tumor progression is not excluded. Would suggest close follow-up evaluation.