Asymmetrical intermediate T1 and enhancing tissue extends from the right side of the nasopharynx in the region of the torus tubarius posteriorly and laterally, expanding the pharyngeal mucosal space and extending into ipsilateral longus coli, clivus and occipital condyle. Tissue also involves at least 270° of the high cervical internal carotid artery circumference with the artery passing horizontally along the superior margin of the remaining tissue. Its lumen is not particularly narrowed. This has likely developed and at least progressed since CT. Presumably this reflects the biopsy proven recurrence ( on the right rather than left ). Enlarged right lateral retropharyngeal node is also present, measuring 22 x 5 x 5 mm.
Mastoid air cells are opacified bilaterally, previously aerated on CT.
In addition, there is some poorly enhancing tissue extending from the anterior aspect of the surgical cavity into the expected location of the frontal sinuses with areas of bony deficiency in these regions. This has not significantly changed from the previous CT and may reflect iatrogenic surgical material.
New and markedly irregular plaque-like enhancing dural thickening which has a T2 hypointense component laterally and a more medial T2 hyperintense component which overlies the left cerebral convexity, not clearly continuous with enhancing tumour extracranially. In addition there is extensive oedema in the underlying white matter and some areas where normal cortex cannot be defined between the enhancing lesion and white matter, highly suspicious for direct parenchymal invasion.
Associated mass effect with distortion and partial flattening of the left lateral ventricle and 2-3 mm subfalcine herniation to the right.
Right frontal encephalomalacia is noted, unchanged and presumably related to previous therapy.
Direct tumour extension from the right nasopharynx to involve right skull base with broad based contact of the high right cervical ICA.
Aggressive dural based lesion over the left convexity with almost certain associated underlying parenchymal invasion. Dural metastasis and invasive meningioma are the main differentials, the former favoured given disease progression elsewhere.