Clinical question: 51-year-old female with metastatic renal cell cancer status post S RSto Right cerebellum, evaluate for progression. Signs and symptoms: None Pre and post enhanced brain MRI:Examination demonstrate slight interval increased size of a hemorrhagic metastatic lesion in the right cerebellum. It measures 16.5 x 20 mm in transaxial dimensions which is slightly larger than prior study. Measurement of 14.7 x 18.3 mm. There is also interval increased surrounding vasogenic edema with resultant regional mass effect.A tiny focus of hemorrhagic enhancement in the right cerebellar cortex also demonstrates subtle interval increase in the edema and enhancement since prior study. Finding is consistent with additional small metastatic lesion measuring approximately at 5.5 x 6 mm (axial fat-sat post enhanced series 12 image 16) in transaxial dimensions compared to prior study remeasurement of approximately 3 x 4 mm.Diffusion-weighted images are negative and there are stable few nonspecific, nonhemorrhagic and nonenhancing foci of FLAIR/T2 hyperintensity in the subcortical white matter of bilateral cerebral hemispheres. Findings in proper clinical setting could represent minimal chronic small vessel ischemic strokes.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits.Unremarkable visualized paranasal sinuses.
1.Mild interval increased size and surrounding vasogenic edema of a right cerebellar hemorrhagic metastatic lesion as detailed/measured above.2.Mild interval increased edema and size of a hemorrhagic metastatic lesion in the right subinsular white matter as detailed/measure above.3.Negative diffusion weighted series.4.Stable few nonspecific foci of subcortical FLAIR hyperintensity.5.Unremarkable calvarium and all visualized paranasal sinuses.