 There is a 5 x 5 x 5 enhancing lesion in the right precentral gyrus with corresponding mild edema demonstrated on prior study. No other parenchymal lesions or abnormal leptomeningeal enhancement.Again seen is a 2 cm enhancing lesion involving the left frontoparietal calvarium at the level of the coronal suture consistent with metastasis. There is minimal adjacent dural enhancement favored to reactive, with early dural invasion not entirely excluded.Additional findings including chronic small vessel ischemic changes, chronic left caudate head infarct, and parenchymal volume loss better demonstrated on prior study with multiple precontrast sequences. No evidence of intracranial mass effect, midline shift, or herniation. Chronic right medial orbital wall fracture with medial herniation of fat again seen.
1. 5 mm enhancing lesion in the right posterior frontal lobe consistent with metastatic disease. No other lesions or significant intracranial mass effect is appreciated.2. Enhancing left frontoparietal calvarial lesion also highly suspicious for metastasis. There is minimal adjacent dural enhancement which is favored to be reactive, with early dural invasion not entirely excluded.3. Additional findings including chronic small vessel ischemic disease and chronic left caudate head infarct better demonstrated on recent MRI from 10/19/2015.