Clinical question: History of metastatic esophageal cancer; previously received SRS to left precentral gyrus lesion. Evaluate disease status. Signs and symptoms: Metastatic breast cancer. Pre and post enhanced brain MRI:Examination demonstrates a small enhancing metastatic lesion superficially in the cortex of left precentral gyrus measuring approximately 10.5 mm in length compared to prior study measurement of approximately 7.8 mm. There is minimal surrounding FLAIR hyperintensity representing edema. Examination additionally demonstrate metastatic lesions in the right postcentral gyrus (axial post enhanced series 12 image 9) measuring approximately 4 mm in transaxial dimensions which was not present on prior exam. There is also a second smaller 3 mm enhancing lesion (axial post enhanced series 12) image 8) which was noted as a punctate focus of enhancement on prior study and with interval progression.Also new since prior exam is a 3.8 mm focus of enhancement (sagittal post enhancement series 13 image 19) in the medial aspect of the left posterior temporal lobe measuring. This lesion demonstrate no associated vasogenic edema or mass effect.Post enhanced images also redemonstrate a small developmental venous anomaly in the left angular generous.Moderate scattered subcortical, periventricular and basal ganglia FLAIR hyperintensity consistent with chronic small vessel ischemic strokes without significant change since prior exam.No detectable calvarial lesions.Unremarkable images through the orbits and including axial fat sat post enhanced series.
1.Interval increased size and edema of metastatic lesion in the left precentral gyrus at 10.5 mm compared to prior study measurement of 7.8mm.2.Metastatic lesion in the right postcentral gyrus with interval increased size as detailed.3.Interval increased size of a punctate lesion in the medial aspect of the left posterior temporal lobe to 3.8 mm compared to prior study.4.Additional tiny enhancing metastatic lesions in the right postcentral gyrus which cannot be identified on prior exams.