Clinical question: Evaluate for growth of astrocytoma. One month post RT/TMZ scan. Pre-and post-enhanced brain MRI:No diffusion weighted abnormalities.Examination demonstrates a flair/T2 hyperintense well demarcated mass centered at the left thalamus. It demonstrated regional mass effect and without detectable surrounding vasogenic edema or enhancement. On axial T2 series it measures 39 times 24-mm in transaxial dimensions which is nearly identical to prior exam. It also measures at 31.5 mm in venous axis and coronal T2-weighted images similar to prior study.The mass apply subtle mass effect on the third ventricle and trace midline shift to the right however without evidence of ventriculomegaly.Similar to prior exam there is a second small focus of T2/flair hyperintensity in the medial aspect of the left anterior temporal lobe without enhancement. This lesion is not in continuity with the mass within the left thalamus which is a similar observation is prior exam. This finding results in subtle increased volume and measures at 13 times 14-mm in transaxial dimensions on T2 flair series. This finding is also suspected of representing a neoplastic process. Additionally few small scattered foci of flair hyperintensity in the periventricular and subcortical white matter without enhancement or interval change since prior exam. Although nonspecific the findings could represent minimal chronic small vessel ischemic strokes.There is revisualization of a left anterior paramedian burr hole representing the site of prior surgical approach for biopsy. A linear susceptibility extends from the level of the burr hole to the anterior/superior aspect of left thalamic tumor and consistent with minimal hemorrhage along the course of biopsy approach.
1.No evidence of an acute or new finding since prior study.2.Stable size, signal intensity and morphology of a left thalamic nonenhancing mass since prior exam.3.Stable small focus of flair/T2 hyperintensity in the medial aspect of the left anterior temporal lobe which could also represent a focus of neoplasm.4.Stable few nonspecific foci of periventricular and subcortical flair hyperintensity.