Female, 48 years old, history of brain metastases and CVA, esophageal cancer, on chemotherapy, status post whole brain radiation therapy, assess response. Redemonstrated is evidence of left frontal craniotomy. A resection cavity within the subjacent frontal lobe as well as surrounding T2 hyperintensity are not significant changed. Enhancement along the margins of the cavity has also not significantly changed.Also seen is evidence of a prior small left posterior parietal craniotomy. Small areas of T2 hyperintensity within the subjacent left temporal lobe are unchanged. No pathologic enhancement is seen within this resection bed.Four previously demonstrated enhancing lesions are again seen involving the right orbital gyrus, the right medial temporal lobe, and both cerebellar hemispheres. There has been no significant interval change in the size or morphology of these lesions, and no significant change in the degree of surrounding T2 hyperintensity. Several punctate foci of cortically-based enhancement are again seen involving the right middle frontal gyrus, right parietal lobe, and in the left occipital lobe (see key images). Most of these have not significantly changed from prior, and some lesions which were seen on the prior exam are no longer evident. They all correspond to areas of acute ischemia as demonstrated on the examination of 10/9/14.Sequelae of prior bilateral watershed and cortical ischemia are redemonstrated within the cerebral hemispheres and cerebellum. T1 hyperintensity along the superior frontal sulci may reflect cortical laminar necrosis. No evidence of new acute ischemia is seen.Scattered small foci of T2 hyperintensity within the periventricular white matter are demonstrated, not significantly changed and likely representative of chronic ischemic injury. A diffuse ill-defined periventricular hyperintensity, particularly along the occipital horns, has mildly progressed and may reflect the secondary effect of radiation.
1. Multiple intracranial enhancing lesions presumed to represent metastases have not significantly changed from the prior exam. No definite evidence of any new metastatic lesion is seen.2. Sites of prior surgery in the left frontal and left temporal lobes demonstrate a stable appearance with no evidence to suggest recurrent/progressive disease.3. Fluctuating punctate foci of cortically-based enhancement correspond to the sites of prior ischemic injury, likely representing evolution of ischemic injury, perhaps compounded by the effects of radiation. Continued attention to these lesions will be necessary on subsequent studies.