Follow-up of right temporal mass. Nocturnal seizures and +ANA. The well-circumscribed, cortically-based, round, 9 mm T2 hyperintense lesion involving the posterior right middle temporal gyrus has not changed in size. However, it is more conspicuous on FLAIR sequence, despite the last exam being performed at 3T. T2 appearance is similar. It continues to show relative mild T1 hyperintensity centrally. A smaller teardrop-shaped lesion measuring 5 mm is located just deep to this lesion in the posterior right temporal lobe. While this also has not changed in size, it has become more FLAIR hyperintense. The lesions show very minimal, if any, central contrast enhancement, most convincing on the most delayed sagittal T1 postcontrast images. The lesion seems to be less contrast-enhancing than on the previous examination although this is favored to relate to differences in timing acquisition after contrast administration. Perfusion imaging does not demonstrate any hyperperfusion in the area of the dominant lesion, although evaluation is perhaps slightly limited due to the lesion's small size.There are a few scattered foci of right cerebral white matter apparent FLAIR hyperintensity, which appear to be artifactual from scalp vessel pulsation, as no definite corresponding T2 abnormality is seen.Remainder of the brain appears unremarkable with no other areas of abnormal enhancement. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. There is asymmetry in size involving the lateral ventricles which is a normal variant. No hydrocephalus. No extra-axial collections. Bone marrow signal is within normal limits. Major flow-voids are preserved.
The 2 adjacent lesions in the right temporal lobe have not changed in size although they are better delineated on FLAIR images when compared to June 2015. They are also less contrast enhancing although this can be due to differences in technique. As discussed previously, the lesions may relate to a DNET, with the differential also including ganglioglioma, low grade astrocytoma, less likely.