Reason: metastatic RCC with new brain mets now s/p radiosurgery; please evaluate response History: brain metastases. Previously seen right posterior temporal lesion is not significantly changed in size measuring 20 x 20 x 19 mm, previously 19 x 18 x 19 mm but demonstrates slight interval increase in intrinsic T1 hyperintensity and slight decrease in enhancement. Interval increase in susceptibility effect is also noted within this lesion consistent with increased blood products.Left posterior frontal lobe lesion demonstrates interval increase in intrinsic T1 hyperintensity and susceptibility consistent with blood products. There is slight decrease in associated enhancement. This lesion measures 20 x 21 x 20 , previously 19 x 20 x 18 mm.No new mass or focus of enhancement is seen to suggest progression of metastatic disease. No new edema, mass effect, midline shift or herniation. No hydrocephalus.There are a few punctate foci of increased T2 signal scattered throughout the cerebral white matter without enhancement or mass effect and are nonspecific. The major cerebral flow voids are intact. Bone marrow signal and extracranial soft tissues are unremarkable.
1.No significant change in size of the left posterior frontal lobe and right posterior temporal lesions. There is however interval increase in blood products within the lesions and mild decrease in enhancement, findings compatible with treatment-related change. No new lesions or findings to suggest progression of metastatic disease.2.No significant edema or mass effect. 