Diagnosis: Secondary malignant neoplasm of brainClinical question: history of metastatic RCC to brain s/p resection. MRI for radiation treatment planningSigns and Symptoms: headacheComments: MRI must be down with contrast even with low GFR. | MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 demonstrate opacification of the sphenoid sinuses and scattered opacities in the posterior ethmoid air cells. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI pituitary:There is a 16 x 12 mm sagittal dimension sellar and suprasellar mass which bulges into the medial aspects of the cavernous sinuses. It is associated with superior displacement of the optic chiasm. This has not changed substantially in size compared to the prior exam.The patient status post transsphenoidal surgery.The cavernous sinuses are intact bilaterally.
1.Compared to the prior exam from December 16, 2015 there is no significant change in the size of the patient's sellar and suprasellar mass which is known to represent metastatic clear cell renal cell carcinoma.2. The patient is status post transsphenoidal surgery.3.There is no evidence for brain metastases.