Male, 36 years old, with anaplastic astrocytoma status post surgery, RT and TMZ, now off all therapy. The right middle frontal gyrus resection cavity is again seen appearing similar in size and shape to prior exams. The degree and extent of T2 hyperintensity surrounding the resection cavity are unchanged. No suspicious enhancement is seen within or along the margins of the cavity.Two foci of enhancement seen previously within the right superior temporal gyrus show no significant interval change from the immediate prior exam. Several additional foci of enhancement are also seen within the right insula. One rather linear lesion demonstrates slightly more conspicuous enhancement (see image 87 series 1401), and increased FLAIR hyperintensity. A second lesion more anteriorly within the insula (image 93 series 1401), is new or increased in size from prior. One or two additional small lesions, however, are smaller when compared to prior exams. Apart from this, no new areas of pathologic enhancement or parenchymal signal abnormal are seen. No significant generalized mass effect or parenchymal edema is noted. No acute intracranial hemorrhage or any new abnormal fluid collection is detected. The ventricular system is normal in size and morphology. A chronic presumed left orbital floor fracture is again seen with fat herniation into the maxillary sinus.
1.Stable appearance of the right frontal lobe resection cavity with no new or concerning features in the immediate surrounding parenchyma.2.Several nonspecific foci of enhancement are seen involving the right superior temporal gyrus as well as the right insula. Some of these are stable in size, some new or slightly more conspicuous, and others are smaller when compared to prior exams. Given this somewhat waxing and waning pattern, these may simply represent a posttreatment effect, though continued close follow-up should be considered.