65 years, Female, history of brain metastases. Follow-up evaluation. Lack of contrast limits evaluation for small metastatic lesions. Postoperative changes of right parietal craniotomy and tumor resection are redemonstrated. Areas of encephalomalacia in the right parietal lobe are again seen and appear to demonstrate slight evolution with mild increase in area of cystic change involving the right superior parietal lobule. Extensive T2/FLAIR hyperintensity within this region, bilateral periventricular and subcortical white matter, and pons is largely similar to prior and reflective of posttreatment changes and/or advanced chronic small vessel ischemic disease. There is however focal interval increase in FLAIR hyperintensity involving the right inferior frontal gyrus without discrete underlying mass. No associated restricted diffusion or susceptibility to suggest acute ischemia or hemorrhage, respectively. There is no significant evidence of intracranial mass effect, midline shift, or herniation. Ventriculomegaly is not significantly changed. Remainder of the calvarium and extracranial soft tissues are grossly unremarkable.
Please note lack of contrast limits evaluation for small metastatic lesions. Compared to 3/1/2015, there is focal increase in T2/FLAIR hyperintensity within the right inferior frontal gyrus. This finding may be related to interval ischemia within this region or evolution of posttreatment change; however, there is possibility that this represents a new area of edema associated with an underlying small metastatic lesion which is not discernible in the absence of contrast. Suggest postcontrast sequences for further assessment. Otherwise, remainder of the brain demonstrates extensive posttreatment changes, particularly in the right parietal region, similar to prior study and without a large intracranial mass or new mass effect. Areas of increased cystic change in the right parietal lobe are favored to represent evolution of posttreatment change, but can also can be better assessed with post gadolinium sequences.