 There is a stable enhancing nodule in the posterior paramedian right cerebellum that measures approximately 6 x 4 mm. This lesion demonstrates a susceptibility signal and is most consistent with previous hemorrhagic metastatic lesion. The lesion is unchanged since the previous study.The nonenhancing focus that was seen in the left posterior temporal lobe in the previous study is still visualized; however it is less conspicuous with decreased enhancement. The remaining tiny metastatic lesions that were seen in the previous study in the supratentorial and in the cerebellum are no longer visualized.There is nonspecific T2/FLAIR hyperintensities in the subcortical and periventricular white matter and in the pons, representing chronic ischemic changes or posttreatment changes. These hyperintensities are unchanged since the previous study.There is no restricted diffusion. There is a punctate focus of susceptibility in the left parietal lobe, representing old blood product.There is mucosal thickening of the bilateral maxillary sinuses and the left sphenoid.Scattered foci of T1 hyperintensities are seen in the calvarium similar to prior. No destructive lesions within the calvarium are appreciated.
Again seen is a small metastatic lesion in the right cerebellum that is unchanged in size and in pattern of enhancement since the previous study. The tiny focus in the left posterior temporal lobe seen in the previous study is less conspicuous with decreased enhancement. No new lesions.Patchy and confluent foci of FLAIR hyperintensity of bilateral hemispheric white matter and pons are compatible with small vessel ischemic disease and/or posttreatment-related changes. No significant intracranial edema, mass effect or ventriculomegaly.