 There are multiple new foci of abnormal parenchymal enhancement suspicious for progression of metastatic disease. -Three foci of abnormal enhancement involving the posterior paramedian frontal lobes which appear new since 2/9/2015. There is a 6 mm enhancing nodule on the right and 4 and 5 mm nodules on the left. These are best seen on series 10 axial images 4-6. -There is also focus of enhancement involving the cortical surface of the right inferior parietal lobule adjacent to a vessel, axial image 11 which is also new.-Additional punctate foci of enhancement are seen in the right occipital lobe, sagittal series 11 image 13, and axial series 10 image 19, and right inferior frontal lobe sagittal image 6 and axial image 14. -Additional scattered foci of T2/FLAIR hyperintensity are seen including the bilateral anterior subcortical frontal white matter as well as lateral aspect of the left precentral gyrus without definite associated enhancement. Punctate focus of susceptibility is associated with the focus of FLAIR hyperintensity in the left precentral gyrus.There is mild edema without significant mass effect associated with these small lesions. No midline shift or herniation. No hydrocephalus. Small arachnoid cyst suspected in the posterior fossa on the left with mild effacement of the left cerebellar hemisphere.Two foci of susceptibility effect in the right frontal lobe and one in the right cerebellar hemisphere are unchanged and compatible with chronic microhemorrhages.Bone marrow signal and extracranial soft tissues are grossly unremarkable.
1. Compared to 2/9/2015, there has been development of at least six new subcentimeter foci of abnormal parenchymal enhancement consistent with progression of intracranial metastatic disease. There is mild associated edema without midline shift or herniation.2. Chronic microhemorrhages in the right frontal lobe and right cerebellar hemisphere are unchanged and may represent previously treated metastases. There is also a new focus of susceptibility effect with associated T2/FLAIR hyperintensity involving the left lateral aspect of the precentral gyrus without definite enhancement which may represent a new microhemorrhage. Although no definite associated enhancement is appreciated, underlying metastasis is not entirely excluded.