 There is no acute infarct, mass effect or midline shift. There is an enhancing region in the left anterior temporal lobe measuring 6 mm compared to 8 mm previously and more homogeneously enhancing internally. A second left anterior temporal lobe focus of enhancement more inferiorly is less well defined and probably unchanged. There are numerous scattered bilateral punctate to small foci of susceptibility effect are grossly unchanged. There is an unchanged 6 x 5 mm left intraconal orbital enhancing metastasis. There are multiple calvarial metastases including a lesion at the vertex of the skull, left frontal bone and the left pterion which are unchanged in size; however the left frontal lesion and lesion at the vertex enhance significantly less compared to the prior exam. There is persistent left greater than right mastoid opacification which is overall decreased.
1.No new intracranial metastases.2.Stable to slightly smaller metastases in the left anterior temporal lobe and the calvarium (in terms of size), but with different enhancement characteristics as described above.3.Stable small left intraconal orbital metastatic nodule.4.No acute infarct, mass effect or midline shift.