Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: 74 yo F with metastatic melanoma to brain, eval for recurrence, prior SRS to L frontal resection cavity There is a focus of encephalomalacia associated with susceptibility effect located in the left frontal lobe. The patient is status post left frontal craniotomy.There is redemonstration of a 5 mm focus of enhancement along the anterior and medial aspect of the left temporal lobe at the anterior aspect of the fusiform gyrus which was also present on the prior exam and is unchanged.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is a small left temporal lobe lesion at the anterior aspect of the fusiform gyrus present which is fairly stable compared to the prior exam and compatible with metastasis.2.There is encephalomalacia in the left frontal lobe associated with some blood products at the prior surgical bed. There is no evidence for local recurrence.3.Examination was performed for purpose of treatment planning for stereotactic radiosurgery.