Chronic ETOH. History of radiosurgery for menegioma Since the prior exam there has been change in the imaging characteristics related to patient's extra-axial parafalcine mass. The mass currently measures 24 x 22 mm coronal dimensions and the 24 x 22 mm axial dimensions and previously measured approximately the same dimensions. The enhancement pattern has changed dramatically in that it is no longer homogeneously enhancing but the rather ring enhancing. Additionally there is enhancement along the adjacent brain parenchyma associated with T2 and flair signal change along the adjacent left parietal lobe and cingulate gyrus and corpus callosum. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a cystic lesion in the left posterior fossa measuring 62 x 20 mm and axial dimensions which previously measured approximately same and that likely represents an arachnoid cyst.There is redemonstration of an extra-axial lesion adjacent to the right temporal lobe which insinuates itself into the surface of the right temporal bone which remains stable and compared to prior exam. This enhances following contrast administration and is somewhat heterogeneous but predominantly dark on T2 imagingThere is redemonstration of a left to inferior temporal gyrus lesion measuring 6 mm in diameter. This is associated with susceptibility effect. It enhances homogeneously and is dark on T2 imaging.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Since prior exam the patient has developed a thin abnormal enhancement pattern associated with signal changes in the brain parenchyma adjacent to the patient's extra-axial mass suspected to represent meningioma. The findings are suggestive of radiation necrosis. Overall the patient's meningioma remains stable in cross-sectional dimensions, but appears at least in part to have necrosed.2.There is a small left temporal lobe mass present along the left inferior temporal gyrus which is unchanged compared to prior exams. It is nonspecific continued follow-up suggested. Signal characteristics just immediate partially calcified. A CT exam may be helpful.3.A small extra-axial mass adjacent to the right temporal lobe embeds itself and to the right temporal bone and is stable since the prior exam.4.There is redemonstration and no change in an arachnoid cyst located in the posterior fossa.