56 years, Male, Reason: Patient with hx of right tonsil cancer treated in 2012 with CRT. Now with new onset right horner' s, right hypoglossal weakness and dysphagia Brain: Please note lack of contrast limits evaluation for small metastatic lesions. Within this limitation no intracranial mass, mass effect, or evidence of edema to suggest metastatic disease is appreciated. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Major flow-voids are preserved.There is opacification of the bilateral ethmoid air cells, right sphenoid sinus, as well as mild mucosal thickening involving the maxillary sinuses, similar to prior CT from 9/13/2013. No destructive lesions within the calvarium.Neck: There are posttreatment changes in the neck including asymmetrically increased soft tissue thickening along the right carotid sheath, which was seen on prior CT as well. There is asymmetric volume loss involving the right aspect of the tongue with rightward deviation of the extrinsic tongue muscles. There is also posterior displacement of the right posterior tongue which may also be related to denervation. There is also increased volume loss involving the right sternocleidomastoid muscle and trapezius when compared to prior study from 9/13/2013. No obvious destructive mass at the right skull base or elsewhere in the neck is appreciated within the limitations of noncontrast MRI.No discrete neck mass or significant cervical lymphadenopathy is appreciated within the limitations of noncontrast MRI.
1. Please note lack of contrast limits evaluation, especially for perineural tumor spread. There is soft tissue thickening in the right neck which is grossly similar to prior neck CT and favored to be related to posttreatment change. No discrete neck mass or significant cervical lymphadenopathy is appreciated. 2. Volume loss involving the right oral tongue, posterior displacement of the right posterior tongue, and volume loss involving the right trapezius and sternocleidomastoid muscles. These findings all appear progressed/new since prior CT from 9/13/2013 and most compatible with multiple lower cranial neuropathies. No discrete mass at the right skull base is appreciated within the limitations of noncontrast MRI. If patient is not on dialysis and GFR is greater than 30, consider postcontrast sequences with half dose gadolinium to better exclude the possibility of recurrent neoplasm.3. No intracranial mass, mass effect, or edema within the brain to suggest intracranial metastases is seen. 