Multiple hemangioblastomas. Evaluate for change. The study is at least mildly limited by patient motion.There are changes of previous right frontal and midline posterior cranial fossa craniotomies. Accounting for chronic blood products in these regions, there is no acute intracranial hemorrhage. There is no acute infarct. Contrast-enhancing nodular thickening of the inferior interhemispheric frontal dura and leptomeninges is not significantly changed since March 9, 2016 examination. However, there is suggestion of minimal increase since November 2015 but the previous examination did lack high resolution, 3-D imaging post contrast imaging. For example, the maximum width of the nodules is 13 mm compared to 12 mm in November 2015. The extensive associated bifrontal white-matter T2/FLAIR hyperintense signal without mass-effect remains unchanged and may, at least in part, reflect posttreatment change.The multiple contrast-enhancing nodules within the posterior fossa are not significantly changed since the 2 previous examinations. The associated T2/FLAIR signal intensity in both cerebellar hemispheres, right more than left, and the associated mild mass-effect remain unchanged. There is encephalomalacia involving the medial aspect of the left cerebellar hemisphere which is unchanged with a tiny contrast-enhancing nodule adjacent to the surgical cavity in the left cerebellar hemisphere. Cervical hemangioblastoma lesions are only partially included. There are scattered small foci of white matter T2 hyperintensity which are unchanged and nonspecific, perhaps representing microvascular ischemic disease. There are no significant parenchymal changes otherwise.There is a retention cyst in the right maxillary sinus, which was present previously. There is mild anterior ethmoidal and left maxillary mucosal thickening. The orbits are unremarkable.
1. Findings compatible with hemangioblastomatosis are not significantly changed apart from probable minimal increase of the frontal interhemispheric leptomeningeal/dural thickening and nodularity when compared to the November 2015 examination. However, this November 2015 examination was of lower spatial resolution than the current examination, with clear progression since the more remote comparisons.2. The numerous enhancing nodules within the posterior fossa remain unchanged as well as the associated cerebellar edema and mild mass-effect on the fourth ventricle.