Male, 71 years old, history of esophageal cancer and brain metastases, status post resection/drainage of cystic lesion, status post SRS in 7/14. There is an enhancing lesion involving the left parieto-occipital lobe measuring approximately 4.2 x 2.3 x 3.4 cm in the AP, transverse, and craniocaudal dimensions, respectively. Most recent MRI was obtained without gadolinium. Compared to earlier MRI brain with gadolinium dated 1/19/2015, there is been marked interval increase in size of this enhancing lesion, at which time it measured 17 x 20 x 18 mm. There is gradually increasing associated edema compared to 1/19/2015 and 4/16/2015. Enhancement extends to the left lateral ventricular surface. Again seen is susceptibility compatible with chronic blood products within this lesion. Restricted diffusion is noted along the inferior aspect of the lesion which may related to blood products.There is increased associated mass effect with effacement of the left parieto-occipital sulci as well as increased effacement of the left lateral ventricle. 6 x 7 x 8 mm mm enhancing lesion in the right cerebellar hemisphere is not significantly changed in size compared to 1/19/2015. There is relatively mild associated FLAIR hyperintensity which is slightly increased since 1/19/2015 and may be related to treatment changes.No new enhancing lesions are seen within the brain to definitively indicate progression of intracranial metastatic disease. There is no midline shift or evidence of downward herniation. Parenchymal volume loss is again seen including in the cerebellum. Left posterior parietal burr hole again seen related to prior drainage/resection.
1. Please note most recent MRI brain dated 4/16/2015 was obtained without gadolinium. Compared to MRI brain with gadolinium from 1/19/2015, there has been marked increase in size of the left parieto-occipital enhancing lesion as well as gradually worsening associated edema and mass effect compared to 4/16/2015 and 1/19/2015. Findings may represent radiation necrosis although recurrent tumor is not entirely excluded. Consider follow-up PET or MRI with perfusion and spectroscopy sequences for differentiation. Of note, prior PET dated to 2/12/2015 did not demonstrate significant uptake within this region, favoring radiation necrosis.2. Small right cerebellar enhancing lesion is not significantly changed in size.3. No new lesions are seen to definitively indicated metastatic disease progression.