Renal cell carcinoma with hemorrhagic brain metastasis, status post resection. Postoperative surveillance and planning for radiation. Please note limited sequences were obtained for treatment planning protocol. Again seen are postsurgical changes of left frontal craniotomy for tumor resection and hematoma evacuation. There is evolution of postoperative blood products with T1 hyperintensity now seen in the previously seen extra-axial collection beneath the left frontal craniotomy. There is a 18 x 15 mm lesion involving the superior aspect of the resection cavity which is hyperintense on the post gadolinium 3-D T1 weighted images and demonstrates a rim of susceptibility effect and favored to represent a hematoma. Similar lesion was present on prior MRI from 1/20/2015. There is edema in the left frontal lobe which is decreased since prior. There is also decrease in associated mass-effect including rightward midline shift and decreased effacement of the left lateral ventricle.No new lesion or new mass-effect is seen on the postcontrast sequence. No hydrocephalus. Postsurgical changes related to posterior wire fixation at C1-C2 level noted.
Examination limited to sequences for treatment planning demonstrates evolution of postsurgical changes including hemorrhage within the left frontal lobe. 18 x 15 mm lesion along the superior aspect of the resection cavity probably represents a hematoma. Please note however for surveillance of metastatic disease, complete brain MRI including pre-gadolinium T1-weighted sequence should be considered.