70 years Female (DOB:10/3/1946)Reason: 70 yo F with brain metastases from melanoma, diagnosed in 11/2016 status post combined BRAF/MEK inhibitor therapy, referred for consideration of SRS, eval sizes of lesions History: nonePROVIDER/ATTENDING NAME: SEAN PITRODA STEVEN J. CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an 11 mm enhancing lesion present within the left frontal lobe along the anterior aspect of the left middle frontal gyrus. It has a heterogeneous appearance on T2 and FLAIR imaging. Some punctate foci of susceptibility effect are present within the lesion. This previously measured 17 mm.Additional enhancing lesions with a similar MR characteristics are also present in the left middle frontal gyrus posteriorly measuring 7 mm and previously measuring 10 mm, in the left occipital lobe laterally measuring 7 mm and previously measuring 10 mm, along the left posterior temporal lobe measuring 4 mm and previously measuring 11 mm, along the left posterior temporal lobe measuring 3 mm and previously measuring 5 mm, along the right anterior temporal lobe measuring 7 mm and previously measuring 11 mm, along the left cerebellar hemisphere medially measuring 4 mm and previously measuring 8 mm. In compared to the prior exam it appears little smaller. Along the right cerebellar hemisphere previously measuring 2 mm and currently measuring 2 mm.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.
There are multiple lesions scattered throughout the brain parenchyma which are compatible with metastatic disease which has regressed compared to the previous exam. Similar signal characteristics and height at these are hemorrhagic type metastatic lesions. This consistent with the diagnosis of melanoma.