 Is a large solid and cystic mass in the left cerebellar hemisphere, currently measuring 2.4 x 2.8 cm in greatest axial dimensions, x 1.7 cm CC. This appears similar to the prior outside MRI. It abuts the inferior margin of the distal left transverse sinus without definite invasion or narrowing. There is an additional ring-enhancing low central signal intensity lesion in the right posterior peripheral occipital lobe, measuring 1.4 x 1.2 cm in greatest axial dimensions, x 1.1 cm CC. This previously demonstrated more homogeneous central enhancement on the outside images. There is an additional nodular area of enhancement in the midline posterior inferior vermis measuring up to 5 mm in greatest axial dimensions (501/69, 502/174), which can be identified on the prior exam with a similar appearance.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There is scattered foci of punctate T2 hyperintensity within the subcortical white matter bilaterally, although not as well delineated given lack of FLAIR images. There is also corresponding T2 hyperintensity to the above-described larger parenchymal lesions. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
1. Redemonstration of dominant left cerebellar and smaller right occipital lobe enhancing lesions, consistent with known areas of presumed metastatic disease. Interval decreased central enhancement of now ring-enhancing right occipital lesion.2. Additional small focus of nodular enhancement in the posterior inferior vermis, also suspicious for metastatic disease.3. Grossly stable scattered punctate foci of T2 hyperintensity in the subcortical white matter which are nonspecific.