Clinical question: History of meningioma resection, evaluate site for residual or recurrence. Signs and symptoms: None surveillance scan. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates a large focus of hemorrhagic cystic encephalomalacia in the right posterior parietal lobe at the site of previously resected tumor. There is abnormal signal intensity with mild enlargement of the superior sagittal sinus at the surgical site which is in continuity with a dural base right posterior parietal loculated isointense T2 signal mass. The finding within the superior sagittal sinus and adjacent dura demonstrate uniform intense enhancement and consistent with residual meningioma. The combination of findings measures approximately 12 x 19.5 mm in transaxial dimensions (axial T1 series 901 image 27) and at least 37 mm intracranial cephalad axis on sagittal post enhanced images.There is also a tiny focus of residual tumor to the left of superior sagittal sinus in the left parietal measuring approximately 9 x 6 mm in transaxial dimensions measured on axial post enhanced series 1001 image 27.Combination of findings in the superior sagittal sinus and bilateral posterior parietal measure approximately at 32 mm along the inner table of the skull and 14 mm in AP axis.Multiple small foci of FLAIR hyperintensity and a confluent foci in the left posterior parietal white matter grossly similar to prior exam and suggestive of chronic small vessel ischemic strokes as well as possible post radiation change overlap. Similar to prior exam there is complete opacification of left frontal sinus demonstrating isointense signal on T1 and T2 and hyperintense FLAIR with rim enhancement consistent with chronic long-standing sinus disease without change since prior exam from February 2015. The rest of the paranasal sinuses remain well pneumatized and with intravenous and mild bilateral ethmoid disease.
1.Signal abnormality and dural based enhancement in bilateral paramedian posterior parietal and continuous through the superior sagittal sinus consistent with residual meningioma as detailed and measuring at 12 x 19.5 x 37 mm.2.Extensive cystic and minimally hemorrhagic encephalomalacia at the site of previously resected meningioma in the right posterior parietal as detailed.3.Stable diffuse punctate and patchy white matter FLAIR hyperintensity since prior exam and likely representing chronic small vessel ischemic strokes with possible overlapping post radiation changes.