Clinical question: Assess for progression of metastatic lesions. Signs and symptoms: History of metastatic melanoma with prior brain metastases. No new periods of intermittent confusion, concerning for progression of disease. Limited nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted images.Images through posterior fossa demonstrate mildly prominent fourth ventricle and unremarkable otherwise and without interval change.There is a hemorrhagic metastatic lesion in the right occipital lobe without significant surrounding edema measuring 16 x 17 mm in size compared to prior study measurement of 8.4 x 7 mm.A right posterior parietal occipital hemorrhagic metastatic lesion is again noted without significant surrounding edema or mass effect and measuring at 12.3 x 13.4 mm without significant change since prior exam.Metastatic hemorrhagic lesion in the left posterior parietal with extensive surrounding vasogenic edema demonstrates interval increased size and increased surrounding edema and associated regional mass effect. The tumor measures approximately 15 x 16 mm intravenous axial dimensions compared to prior study measurement of 12 x 14.Focus of FLAIR hyperintensity in the right anterior frontal with evidence of hemorrhagic changes demonstrate no significant change since prior study. There is evidence of prior surgical intervention at this site and findings could represent post surgical change.Metastatic lesion in the high convexity right anterior parietal and is surrounding edema demonstrate no significant change. A well demarcated CSF signal intensity cystic-like lesion likely representing postsurgical change in high convexity left paramedian posterior frontal measures up to 24 x 23 without significant change since prior study.Mildly dilated supratentorial ventricular system with maintained midline demonstrate no appreciable interval change. The CSF cisterns and cortical sulci remain patent.
1.Incomplete and nonenhanced MRI of brain is performed due to patient's inability to continue.2.There is no acute intracranial process and negative diffusion-weighted images.3.Interval increased size and surrounding vasogenic edema of the metastatic lesions as detailed/measured above.4.Stable mildly dilated supratentorial ventricular system however with maintained midline.5.Stable postoperative changes as detailed.