Compared to the previous MRI, the size of the new irregularly shaped ring enhancing lesion at the right thalamus/globus pallidus has decreased in size, although this area still demonstrates increased CBV (note area is susceptibility affected). In addition, a more solidly enhancing lesion has developed immediately posteriorly, in the posterior right thalamus with elevated CBV and mild rim diffusion restriction, and associated increased extent of FLAIR hyperintensity with a mild increase in mass-effect.
Spectroscopy again demonstrates regions of elevated choline and lactate.