MRI Results/possible surgery for 6yr old

Hi, my son had an initial brain MRI in March and is being sent for a followup MRI on the 26th of this month. The first MRI showed a lesion in the left frontal lobe and his neuro said if it's still there on the 26th, she wants us to see neurosurgery. It's frightening to say the least and it's not very reassuring that neither the neurologist nor the pediatric diagnostic neuroradiologist have ever seen a lesion present in this fashion in that area before--her words. This is coming from one of the top neuro depts in the country and one of the best ped neurorad's in the US. If someone could maybe explain what the MRI findings mean, I'd greatly appreciate it. Because, right now, I know nothing because the doctors don't know what it is. Thanks!

Technique:

1. 1.5T MRI images of the brain were obtained with sagittal T1, axial T2, axial FLAIR, DWI and ADC maps, coronal T2 and GRE, coronal T2 with special attention to the hippocampi, axial T1 magnetization transfer images,  Post contrast axial and coronal T1 weighted images were also obtained (Gadopentetate-Dimeglumine, 0.2 ml/kg).

2. Additional single voxel MR spectroscopy was also performed of the lateral left basal ganglia.



Comparison: None



Findings: There is an ovoid sharply marginated 6 x 5 mm lesion in the deep posterior left frontal white matter, that is hyperintense on T2/FLAIR and hypointense on T1. No contrast enhancement is identified.

The midline structures are normal. There is normal size and configuration of the corpus callosum. The brainstem and cerebellum are normal. The pituitary gland and stalk, as well as the optic chiasm are normal.



There is normal size and internal architecture of the hippocampi bilaterally. There is mild prominence of the right temporal horn, a normal variant. No signal abnormalities are identified. There is no evidence of cortical dysplasia or heterotopia.



The brain architecture is otherwise normal. There is no bleed or midline shift. The ventricles are of normal size, position, and configuration. No extra-axial fluid collections are seen. The differentiation of gray and white matter is age appropriate.



Gradient-echo images are normal. Magnetization transfer images are normal. No restricted diffusion is noted. There is no abnormal contrast enhancement. MR spectroscopy is normal, no lactate evident.



The flow-voids at the skull base are normal. The visualized portions of the orbits are normal. There is normal aeration of visualized paranasal sinuses.



Impression:

6 mm nonspecific nonenhancing ovoid lesion in the left posterior frontal lobe as described. Appearance is nonspecific; not typical for infarct, demyelination hamartoma, or posttraumatic lesion. Unlikely represents a neoplastic process. Followup MR examination in approximately 6 months time may be of help assess for stability.