 Postoperative changes are again seen from previous right temporal lobe lesion biopsy. Direct comparison to the prior MRI from October 2014 limited due to prior patient motion as well as differences in technique across the 2 exams. Within these limitations, there appears to be interval increased size of the triangle shaped area of CSF signal intensity involving the right fusiform gyrus, likely relating to an area of evolving cystic encephalomalacia. On 3-D T1 weighted images, this area currently measures 9 x 11 mm on 1101/69, compared to previous 7 x 11 mm in October 2013. On the more remote exams, there was more diffuse areas of FLAIR hyperintensity within the right temporal lobe subcortical white matter.Comparison of current coronal FLAIR imaging is slightly limited due to prior differences in angulation, although overall the previous somewhat ill-defined mildly expansile T2/FLAIR hyperintensity in the white matter of the right hippocampal gyrus now appears more diffuse, with involvement of the adjacent cortex and blurring of the gray-white junction.The ventricles and sulci are within normal limits. The basal cisterns remain patent. There is no midline shift or mass effect. There are no new areas of abnormal signal. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is mild mucosal thickening in the sphenoid sinuses and scattered ethmoid air cells bilaterally.
Redemonstration of right temporal lobe findings, including evolving area of cystic encephalomalacia more laterally, as well as areas of abnormal signal and mild expansion/cortical thickening involving the hippocampus and para hippocampal gyrus, with gradual blurring of the gray-white junction when compared to more remote exams. Differential diagnosis again includes an area of cortical dysplasia with possible superimposed low-grade neoplasm.