49 years, Female, metastatic lung cancer, status post SRS, assess for recurrent/progressive disease. Again seen are postsurgical changes of frontal craniotomy for resection of right superior frontal gyrus mass. There is a small focus of enhancement along the medial surface of the right frontal gyrus abutting the falx measuring approximately 6 x 7 x 7 mm and appears more nodular in the interval (best appreciated on coronal series 1201 image 136). There has been further collapse of the underlying resection cavity. There are chronic blood products in this region. Mild T2/ FLAIR hyperintensity in the right superior frontal gyrus is also not significant changed and may represent residual edema and/or gliosis.Remainder of the brain parenchyma is unremarkable for age. No new metastatic foci. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There is interval development of moderate mucosal thickening involving the bilateral maxillary sinuses with small fluid levels, which may reflect acute sinusitis. There is also mild ethmoid and sphenoid sinus opacification.There is diffuse low T1 marrow signal which is nonspecific without discrete destructive osseous lesions.
1. Continued evolution of posttreatment changes of radiation and prior resection of right superior frontal gyrus mass. There is interval increase in nodular enhancement along the medial surface of the right superior frontal gyrus which may represent posttreatment change. Recurrent metastasis seems less likely but would recommend a close follow-up exam to better exclude this possibility. 2. No new foci of metastasis elsewhere in the brain.