20 years, Male, calvarial lesion possibly due to testicular cancer. Germ cell tumor with brain and lung metastases, status post completion of whole brain radiotherapy in March 2014, last chemotherapy administered August 13, 2014, with undetectable beta-hCG and AFP. There is no restricted diffusion to suggest acute ischemia. There are scattered non-enhancing, susceptibility-inducing lesions within the bilateral frontal, parietal and temporal lobes and left cerebellum, unchanged from prior, possibly treated disease/microhemorrhages. For example, a lesion within the left cerebellum measures 4 mm on series 10, image 20, unchanged from prior. There are a few foci of susceptibility within the right frontal lobe and right parietal lobe which are new from prior. An enhancing left parietal calvarial lesion is increased in size measuring 1.1 x 0.3 cm (series 10, image 12), previously 0.5 x 0.3 cm. There is no midline shift or herniation. The ventricles are within normal limits in size and configuration. There is no hydrocephalus.There is no abnormal parenchymal or meningeal enhancement. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1. Increased size of left parietal calvarial enhancing lesion.2. Unchanged nonenhancing, hemosiderin stained lesions within the bilateral frontal, parietal and temporal lobes and left cerebellum, likely representing treated disease or treatment related change.3. Few new punctate foci of microhemorrhage within the right frontal and parietal lobes, as detailed above. 