79 years, Female, parotid cancer status post chemoradiation, now with brain metastasis. Examination is obtained for treatment planning and limited to SWI and post gadolinium 3-D SPGR sequences. There is an enhancing lesion involving the left medial temporal lobe measuring 15 x 15 x 16 mm (previously 12 x 13 x 13 mm) and abutting the left cerebral peduncle and the left optic tract. There is a second enhancing lesion involving the right superior cerebellar vermis measuring 13 x 11 x 11 mm previously 11 x 12 x 11 mm and abutting the right tentorial surface. No findings to suggest associated hemorrhage. There are however additional foci of susceptibility effect including the left cerebellar hemisphere, right parietal lobe, and right temporal lobes compatible with chronic microhemorrhages and are nonspecific in etiology.No findings to suggest intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. Major vascular structures are patent. No destructive calvarial lesions are appreciated.There is evidence of right-sided parotidectomy. There is enhancement of the right facial nerve including its labyrinthine, tympanic, and mastoid segments, similar to prior.
1. Two enhancing lesions involving the left medial temporal lobe and right cerebellar vermis consistent with metastatic disease. These lesions measure slightly larger than on outside study from 8/26/2015. No new lesions.2. Multiple scattered foci of susceptibility effect compatible with chronic microhemorrhages and are nonspecific in etiology. There is no associated enhancement to suggest that these represent active metastases. 3. Evidence of right-sided parotidectomy and enhancement of the right facial nerve. The right facial nerve enhancement appears similar to prior and favored to be related to prior surgery involving the facial nerve. Suggest attention on follow-up however to exclude the small possibility of perineural tumor spread.4. Please note this MRI examination is limited to sequences for radiation treatment planning. 