Diagnosis: Secondary malignant neoplasm of brainClinical question: 61 yo M with metastatic thyroid cancer to brain s/p SRS to L putamen and L posterior parietal resection cavity, known R frontal lesion; eval for progression and new mets The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left parietal craniotomy for left parietal lobe surgery. There is redemonstration of some susceptibility effect along the medial aspect of the left parietal lobe within the precuneus where there was previously a mass. There is no evidence for local recurrence at this time.There is a punctate focus of enhancement present along the anterior aspect of the left putamen. It measures currently 3 mm in diameter and previously measured 5 mm in diameter. It is associated with susceptibility effect. There was also identified in the 7/13/2015 exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.The patient status post left-sided craniotomy for removal of a left precuneus mass. There is no evidence for local.2.There is redemonstration of a tiny lesion in the left putamen which appears smaller on the current exam and is now associated with susceptibility effect. This susceptibility effect is likely treatment related.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 