Prior history of nasopharyngeal cancer.
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Both temporal lobes demonstrate cystic hemosiderin lined change. On the right there is abundant vasogenic edema.
This patient had had previous radiotherapy for nasopharyngeal carcinoma, and now demonstrates typical, albeit pronounced, changes of radionecrosis of the temporal lobes. It is important to note how variable the appearance can be even in the one patient from the one exposure.
CBV and MRS are helpful in demonstrating non-tumor features; low CBV and flat MRS +/- lipid lactate respectively.