Optic gliomas and optic hypothalamic glioma status post chemotherapy. Off therapy evaluation. There has been interval mixed response of enhancing FLAIR hyperintense lesions along the left optic pathway. There has been no significant interval change in the enhancing lesion along the posterior left optic tract, at the level the left ventricular atrium. The lesion along the left optic tract, just posterior to the left optic chiasm is slightly decreased in size. Direct comparison is best made on the coronal T1 fat-sat postcontrast images through the orbits, measuring 5 mm on 1601/13, compared to previous remeasurement of 7 mm. There is also been interval reappearance of an oval enhancing nodule centered just medial to the left pelvis as seen on 1701/13, which had resolved on the March 2015 exam although is smaller than the current size on the December 2014 exam.There is interval further improvement of the enhancing right optic pathway lesions. For reference, enhancing lesion adjacent to the right basal ganglia currently measures 0.4 x 0.4 cm (1701/13), further decreased from previous 0.7 x 0.7 cm. The subtle right hypothalamic punctate lesion is less conspicuous than on the prior exam (1601/14).There is a stable appearance of the intraorbital component of the optic nerve gliomas, right larger than left, again noted to have mild enhancement of the right intraorbital optic nerve and persistent dilatation of the right optic nerve sheath. There is persistent faint intrinsic T1 hyperintensity of the bilateral basal ganglia and dentate nuclei, which may be metabolic in etiology. There is no evidence of acute infarct. The ventricles are mildly prominent, which is unchanged. There is no midline shift. There are punctate foci of susceptibility along the left basal ganglia region likely relating to minimal chronic hemosiderin. There is stable linear FLAIR hyperintensity along the left frontal white matter extending towards basal ganglia.
1.Interval fluctuation in appearance of enhancing lesions along the left optic pathway.2.Interval further improvement of enhancing lesions along the right pathway. 3.Subtle right hypothalamic punctate lesion is unchanged.4.Stable appearing intraorbital component of the optic nerve gliomas.