Male, 48 years old, with history of multiple myeloma and brain metastases, left optic nerve infiltration, status post three cycles of HD methotrexate and proton beam therapy, currently at subacute rehabilitation facility. Brain:Since the prior examination, a right frontal approach ventricular catheter has been placed with its tip in the right lateral ventricle. Minimal evidence of prior endoscopic intervention is also seen.Significant interval improvement is seen in the degree of left frontal edema arising from the previously demonstrated enhancing lesion. Only a small amount of residual T2 signal abnormality and susceptibility effect are seen, and there is no longer any mass effect. Without the benefit of contrast, the size of any residual enhancing component cannot be assessed, though the lesion in its entirety does appear to be significantly smaller. The pineal region mass has also substantially improved such that it is no longer discretely identifiable.No new areas of parenchymal signal abnormality are seen. No abnormal extra-axial fluid collections are detected. Mild interval brain parenchymal volume loss is seen when compared to the prior examination. The ventricles are consequently slightly larger than on prior but they are not dilated. Without the benefit of contrast, abnormalities of the optic apparatus are not adequately assessed. However, no gross optic nerve lesions are seen.Cervical spine:A subcentimeter focus of STIR hyperintensity is unchanged within the C4 vertebral body. No new marrow space lesions are seen. Spinal alignment is anatomic and the vertebral body heights are preserved. The spinal cord demonstrates normal signal intensity and morphology throughout. No focal cord lesions are seen. No epidural abnormalities are suspected. The intervertebral discs are preserved with no areas of high-grade spinal canal or foraminal stenosis.Only the sagittal T1-weighted images of the thoracic spine were able to be acquired. Given this very limited examination, no gross marrow space lesions are seen.
1.Significant interval reduction in the size of the previously seen left frontal lobe lesion with much reduced edema and mass effect.2.Complete or near complete resolution of the previously seen pineal region tumor.3.Given the limitations of a noncontrast examination, no gross abnormalities of the optic apparatus are seen.4.No definite myelomatous lesions are detected in the cervical spine.