Clinical question: Status post SRS brain metastases. Please evaluate for interval change. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Examination demonstrate a stable extensive postoperative changes of right frontal craniotomy. Stable extensive underlying parenchymal flair hyperintensity with minimal internal chronic hemorrhagic changes and without associated mass effect or enhancement.Focus of vasogenic edema in the left occipital lobe surrounding a small necrotic tumor is again noted. There is interval increased vasogenic edema since prior study. There is also slight interval increased size of tumor since prior exam to 25 x 7.6-mm compared to prior study measurement of approximately 4.6 mm. Interval development of necrosis as a result of treatment could result in appearance of pseudo-progression of disease. Further follow-up is needed.Previously noted a small focus of hyperintensity in the left basal ganglial is again identified and with interval decreased size as well as complete resolution of previously noted enhancement/tumor. Nonspecific subtle periventricular foci of flair hyperintensity without hemorrhage or enhancement are nonspecific and could represent mild chronic ischemic strokes however overlapping post treatment change cannot be entirely excluded. This appears overall remains stable since prior exam.Ventricular system remain within normal size and is stable since prior exam with maintained midline.There is no detectable new foci of parenchymal signal change or abnormal enhancement of brain parenchymal or the meninges.Small focus of right temporal bone enhancement demonstrate slight interval decreased intensity of enhancement however without change in size. This observation could indicate improvement.
1.Stable extensive postoperative changes of right frontal lobe tumor resection without evidence of recurrence of disease.2.Slight interval decreased focus of flair hyperintensity and complete resolution of enhancement in the left basal ganglia since prior exam.3.Slight interval increased flair hyperintensity surrounding the left occipital lobe tumor. The tumor demonstrates interval central necrosis and resultant subtle increased size from prior measurement of 4.6 mm the current study measurement of 5 x 7.6mm which could represent pseudo-progression. Further follow up is needed.4.Although there is no appreciable change in the size of a small right squamosal temporal bone metastasis, the decreased intensity of enhancement could conceivably represent improvement. However further follow-up is needed.