79-year-old female patient with failure to thrive, altered mental status. Question of leptomeningeal disease. There are no new foci of restricted diffusion to suggest acute ischemia. Multiple nodular enhancing parenchymal lesions, some of which have intrinsic high T1 signal, within the bilateral hemispheres and left cerebral hemisphere appear unchanged in distribution compared to the prior study. Some of these lesions demonstrate mildly decreased enhancement. Two previously noted lesions within the right superior frontal gyrus and the right pars marginalis demonstrate decreased T2 signal abnormality compared to the prior study. Gyriform enhancement of the right temporal lobe is not significantly changed. Encephalomalacia of the right precentral gyrus is unchanged. No new enhancing lesion is identified. There is interval increase in right parieto-occipital and right temporal white matter T2 signal abnormality, which is presumably related to posttreatment change.There is mild interval increase in size of the lateral and third ventricles as well as the sulci suggesting parenchymal volume loss. The basal cisterns are patent. There is no midline shift or herniation. The major cerebral flow voids are intact. There are postsurgical changes within the right parietal bone. The orbits, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1. Overall, stable distribution of metastatic lesions within the bilateral cerebral hemispheres and left cerebellar hemisphere without new lesion identified or definite progression of existing lesions. 2. Decreased edema within the right frontal lobe and right pars marginalis, compared to the prior study.3. Increased T2 signal abnormality within the white matter of the right parieto-occipital and right temporal lobes which likely represents posttreatment change.4. Mildly increased size of the lateral and third ventricles likely secondary to volume loss.