 Post contrast images are somewhat limited by patient motion. There are prominent areas of susceptibility, intrinsic T1 hyperintensity, and central diffusion restriction corresponding to areas of recently identified parenchymal hemorrhage, along the anterolateral aspect of the cranial margin of the left posterior parietal resection cavity. Previous blood products within the resection cavity have resolved, with residual rim of hemosiderin staining. The area of the hemorrhage measures 1.2 x 1.8 cm in greatest axial dimensions, and appears to demonstrate a dependent blood level.Compared to the prior MRI, there are multiple areas of increasingly confluent but slightly heterogeneous enhancement along the margins of the resection cavity. Direct comparison is somewhat limited due to lack of 3-D T1 post contrast images on the current exam. Overall, the cavity itself is expanded and now FLAIR hyperintense concerning for tumor involvement. Overall extent of prominent left cerebral FLAIR hyperintensity appears similar within the white matter, with extension into the left external and internal capsules. There is progressive extension of abnormal signal into the corpus callosum across midline, as well as mild medial expansion of the abnormal signal along the posterior body of the left lateral ventricle. There is increased midline shift to the right now measuring 8 mm and localized mass effect upon the near completely effaced posterior left lateral ventricle.One of the more confluent areas is identified along the medial aspect of the left ventricular atrium, now measuring 2.3 x 1.9 cm on 1101/14, previously 1.8 x 1.5 cm. There is also a new 1.3 x 1.1 cm area of enhancement along the anterior aspect of the left temporal horn which is now near completely effaced. The previously identified intraventricular nodule along the anterior body of the left lateral ventricle has increased in size now measuring 6 x 7 mm, previously 4 x 5 mm. Overall craniocaudal extent of the area of abnormal enhancement now measures 5.7 cm on 1201/10, compared to previous 3.9 cm.There is stable focal prominence of CSF space along the anterior aspect of the left temporal pole which may represent a small arachnoid cyst, as it is present on the baseline exam from 2009. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
1.Redemonstration of small area of hemorrhage along the superior margin of the previous left parietal resection cavity, with overall progression of tumor within and surrounding the prior resection cavity. Similar degree of associated white matter abnormality to correspond to recent CT, as well as localized mass effect and midline shift with near complete effacement of the posterior left lateral ventricle.2.Further increased size of tumor nodule within the anterior body of the left lateral ventricle.3.New left temporal periventricular tumor involvement.4.Gradual progressive extension of abnormal signal across midline along the corpus callosum increased medial extension of abnormal white matter signal within the adjacent expanded left frontal lobe gyri.