Reason: 61M with NHL with CNS involvement on C5 DA-EPOCH-R. restaging scan History: restaging for CNS involvement. The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam the patient has developed T2 and flair signal hyperintense lesion centered along the right half of the genu the corpus callosum which measures 27 x 14 mm in axial dimensions and 27 x 10 mm coronal dimensions. This crosses the midline and insinuates itself to the adjacent right frontal lobe somewhat like satellite foci. Contrast enhancement appears to involve perivascular space .There are associated with punctate foci of enhancement along the right orbital gyri.Punctate foci of enhancement associated with T2 and flair signal hyperintensity are identified in the globus pallidus bilaterally, left centrum semiovale and the left internal capsule.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mucosal thickening along the sphenoid sinus and scattered opacities in and the other paranasal sinuses. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The left eyeball lens is thin.
1.Since the previous examination the patient has developed a lesion centered in the corpus callosum anteriorly as well as several smaller lesions in globus pallidi and a right orbital gyri . Given the patient's clinical history of lymphoma this is suspicious for a recurrence of lymphoma. The possibility that this represents an infectious process cannot be excluded.2.?????3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 