Reason: hx atypical meningioma. Eval for growth History: none- surveillance Postoperative changes are again seen from previous right parietal craniotomy with paramedian craniectomy with subsequent cranioplasty.There is a small focus of diffusion restriction and intrinsic T1 hyperintensity anterior to the left paramedian parietal resection cavity with peripheral susceptibility, likely representing a small hematoma. There are other areas of other curvilinear susceptibility along the parietal lobes bilaterally, greater on the left side, consistent with chronic hemosiderin deposition. There is a similar configuration of extra-axial fluid subjacent to the craniectomy.There is redemonstration of an irregular heterogeneously enhancing nodule along the left parietal lobe at the upper margin of the resection cavity. Overall the pattern of enhancement appears slightly less confluent than on the prior exam, with a more lacelike appearance despite similar order of postcontrast imaging. This area of nodular enhancement measures up to 2.4 cm on the current exam on 1201/122, compared to previous comparable 2.8 cm. However, the rind of enhancement along the anterior aspect of the resection cavity measures 8 mm in greatest thickness on the current exam, previously 5 mm. In addition, there is a small area of new nodular enhancement anteromedial to the resection cavity as seen on 1201/128 which measures 6 x 5 mm in greatest axial dimensions. More inferiorly, this area of nodularity is again confluent with the prominent nodular enhancement located along the inferior aspect of the resection cavity extending to the right of midline which appears similar in overall size.The degree of T2/FLAIR hyperintensity within the surrounding parietal lobes in a vasogenic pattern appears similar. Areas of cystic degeneration are again seen along the right parietal lobe appears stable in size. Other scattered foci of nonspecific T2/FLAIR hyperintensity are seen within the periventricular and subcortical white matter. Ventricular caliber appears similar consistent with global volume loss.There is persistent left frontal sinus opacification. Scattered ethmoidal air cell opacification is also noted.
1.Findings concerning for slight progression of tumor at the site of prior tumor resection in the high parietal regions, although slight decreased size and confluence of enhancement of the more superior posterior heterogeneous nodule.2.Stable pattern of edema the parietal lobes with evidence of cystic encephalomalacia in the right parietal lobe.3.Small focus of likely interval blood product anterior to the resection cavity.