Renal cell carcinoma with brain metastasis, status post whole brain radiation therapy, surveillance imaging. Allowing for differences in measurement, left parietal lobe (precuneus) lesion measures stable to minimally larger at 6 x 6 x 6 mm, previously 5 x 5 x 4 mm. There is interval decrease in surrounding edema. The enhancing right inferior temporal gyrus lesion measures 4 x 4 x 4 mm previously 3 x 3 x4 mm without significant surrounding edema. The subtle differences in measurement may be related to differences in technique. These lesions are smaller than pretreatment study from 1/14/2015. No new lesions or evidence of intracranial mass effect.There is no evidence of intracranial hemorrhage or acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is minimal fluid in the mastoid air cells and retention cyst formation in the maxillary sinuses.
Stable to minimal increase in size of the residual enhancing left parietal and right temporal lobe metastases. Although the subtle differences in measurement may be related to subtle differences in technique, may consider shorter interval follow-up study. There is continued decrease in mild edema surrounding the left parietal lesion favoring treatment response. No new lesions.