History of metastatic melanoma with brain metastasis status post resection for SRS treatment planning. This is a limited stealth MRI of the brain for treatment planning. There are post-operative findings related to a right frontal craniotomy for tumor resection with more conspicuous rim enhancement of the surgical cavity. There remains dural thickening and enhancement with interval decrease in size of a fluid collection subjacent to the craniotomy flap. There is decreased mass effect on the right frontal horn without significant midline shift. There is evidence of a remote left frontal craniotomy with redemonstration of a resection cavity at the left frontal lobe convexity, which appears unchanged. Redemonstrated is a 9 mm lesion in the right precuneus with associated susceptibility artifact, which is unchanged in size. There is interval progression in size of a punctate 4 mm enhancing lesion in the left precuneus, which in retrospect was present on prior MRI's but more punctate. There is ill-defined, patchy enhancement in the right temporal lobe, which is likely artifactual. Again seen are multiple areas of susceptibility artifact throughout the bilateral cerebral hemispheres, consistent with hemosiderin deposition.
1. Limited stealth MRI of the brain for treatment planning.2. Expected post-operative findings related to a right frontal craniotomy for tumor resection with increased conspicuity of rim enhancement surrounding the resection cavity margin, which is compatible withe evolution of post-surgical change. Attention on follow-up is suggested.3. Punctate 4 mm enhancing lesion in the left precuneus, which is slightly increased in size compared to prior exams. Ill-defined patchy enhancement in the right temporal lobe is likely artifactual. 4. No significant interval change in the appearance of the right parietal precuneus hemorrhagic lesion as well as left posterior frontal resection cavity. 