 There is a rim-enhancing mass measuring 5 x 6 mm within the superior frontal gyrus of the right frontal lobe which corresponds to the FLAIR signal abnormality in the previous exam. The focus of T2/FLAIR hyperintensity in the right temporal lobe does not enhance and may represent artifact on the previous exam. As suggested previously, the nonenhancing focus of T1 hypointensity in the left frontal lobe likely represents small vessel ischemic disease. Again seen is a punctate focus of susceptibility in the right frontal lobe compatible with microhemorrhage and remains nonspecific.The cortical sulci are in proportion to the cerebral ventricles. No intra-axial or extra-axial fluid collections are visualized. There is no midline shift or mass effect. The basal cisterns are visualized. No fluid collections are visualized in the paranasal sinuses and mastoid air cells.
1.A rim-enhancing mass measuring 5 x 6 mm at the right superior frontal gyrus may represent a metastasis.2.The right middle temporal gyrus abnormal FLAIR signal intensity lesion on the prior exam does not enhance thus is unlikely to represent metastatic disease.3.As suggested previously the nonenhancing focus of T1 hypointensity in the left frontal lobe likely represents small vessel ischemic disease.Comment: Since the axial 3D FSPGR was reconstructed with 2mm thickness, this sequence may need to either re-reconstructed with 1mm thickness based on 3D source images for the SRS planning or may be need to repeated.