Clinical question: SRS planning postop. Signs and symptoms: None. Pre-and post-enhanced treatment planning MRI:Examination demonstrate an enhancing metastatic lesion in the right posterior cerebral measuring at 6.2 mm in transaxial dimensions without significant change since prior exam.A right inferior frontal enhancing metastatic lesion measuring at 14 x 14-mm without significant change.An enhancing metastatic lesion immediately lateral to the trigone upright lateral ventricle measuring at 13 x 10 mm without significant change since prior study. A surgical cavity in the right frontal lobe demonstrate a thick and irregular rim of enhancement with interval progression since prior study. The appearance is concerning for local recurrence of tumor. Right anterior frontal extra-axial collection with a thick hemosiderin laden membrane measures maximum of 21-mm thickness with subtle there interval increased size since prior study measurements. Findings results in mass effect on the adjacent parenchyma and right frontal horn of lateral ventricle without deviation of midline.The intracranial venous sinuses are all well visualized and without evidence of abnormality. The bilateral thalamostriate veins, bilateral internal cerebral veins and straight sinus are well visualized and unremarkable.
1.Multiple supratentorial and infratentorial metastatic lesions without significant change or mass effect as detailed/measured above.2.A right frontal surgical cavity demonstrate thick irregular rim of enhancement which is new since prior exam and concerning for possible local recurrence of disease.3.Unremarkable intracranial venous sinuses.4.Large right frontal extra-axial collection as detailed.