 There is now thick irregular enhancement in the site of the previous resection cavity and along the surgical tract in the left occipital lobe. No diffusion restriction in the area of the enhancement. There has been extensive interval increase in the associated T2/FLAIR hyperintensity surrounding the resection cavity, with predominantly white matter involvement although some cortex is also involved. There is associated mass effect, specifically on the left lateral ventricular atrium which is displaced anteriorly and partially effaced, as well as sulcal effacement. No midline shift. No additional enhancing lesions are noted.
Interval significant increased irregular enhancement in the left occipital lobe resection cavity and surgical tract as above. Extensive associated T2/FLAIR hyperintensity with localized mass effect. Differential considerations include radiation necrosis, and perhaps slightly less likely tumor recurrence. Clinical correlation with history of radiation port/field is recommended. Additionally, supplemental MR perfusion imaging, with or without spectroscopy, is recommended for a more complete evaluation.