66 years, Female, stage IV melanoma with brain metastases on treatment. Again seen is a hemorrhagic lesion in the right paramedian occipital lobe measuring approximately 11 x 6 mm, which is not significantly change in size on the T1 weighted sequences since prior MRI from 9/16/2015 (measured11x7 mm), but clearly smaller than 6/1/2015 (measured 16x13 mm). There is intrinsic T1 shortening without clear enhancement. There is mild increase in surrounding FLAIR hyperintensity without mass effect. No midline shift or herniation. No abnormal parenchymal or meningeal enhancement is seen elsewhere in the brain to suggest a new lesion. There are multiple nonspecific foci of scattered T2/FLAIR hyperintensity similar to prior. No hydrocephalus. No extra-axial collections. Diffuse low T1 marrow signal is again noted, which is nonspecific. No destructive calvarial lesions.
1. No new or enlarging lesions to suggest progression of metastatic disease. 2. Treated hemorrhagic right occipital lesion is not significantly changed in size compared to 9/16/2015. There is increase in surrounding FLAIR hyperintensity which may represent mild edema or gliosis from prior treatment.