 There is evidence of intracranial metastatic disease. Contrast enhancing lesion in the left medial occipital lobe measuring 1.0 x 0.7-cm (post contrast image 76) with associated vasogenic edema is compatible with intracranial metastasis. There is a second contrast enhancing lesion in the left cerebellum measuring 1.2 cm x 1.0 cm (post contrast image 38) with associated vasogenic edema. There is also area of FLAIR hyperintensity centered at the left anterior temporal lobe without definite underlying lesion likely related to treatment change. There is however a punctate focus of enhancement in the left anterior temporal lobe which may be related to prior treatment versus tiny metastatic lesion. No evidence of midline shift or mass effect. Additional subcentimeter areas of abnormal enhancement and edema in the bilateral superior/middle cerebellar peduncles may represent additional smaller lesions versus a separate perhaps toxic-metabolic process. There is a 5 mm lesion more laterally in the left superior cerebellum and a punctate lesion in the superior cerebellar vermis (axial image 74/175 series 1301) . Additional symmetric areas of T2 hyperintensity of the periventricular and subcortical white matter are compatible with chronic small vessel ischemic disease or treatment changes. Evidence of prior left frontal and temporal craniotomies. No destructive calvarial lesions. No evidence of acute hemorrhage or infarction. Flow voids are present within the major vessels indicating patency. There is fluid in the mastoid air cells. Orbits are unremarkable.
1.Dominant metastatic lesions in the left medial occipital lobe and left cerebellum. Additional subcentimeter areas of abnormal enhancement and edema in the bilateral superior/middle cerebellar peduncles may represent additional smaller metastases versus a separate perhaps toxic-metabolic/treatment-related process. There is a 5 mm lesion more laterally in the left superior cerebellum and another punctate lesion in the superior cerebellar vermis. No significant mass effect, midline shift, or herniation. Comparison with prior MRI would be helpful if available.2.FLAIR hyperintensity in the left anterior temporal lobe likely represent gliosis related to prior treated lesion. 