Clinical question: History of brain metastases with RT, please evaluate stability. Signs and symptoms: Brain metastases. Pre-and post enhanced brain MRI: Examination demonstrate very significant interval increased size of multiple previously known metastatic lesions and with significant interval increased peritumoral vasogenic edema and associated mass effect.A left high convexity paramedian enhancing/necrotic metastatic lesion abutting the falx measures at 18 x 15 x 18 transaxial dimensions compared to prior study measurement of approximately 8.5 x 10.5 x 10 -mm. Significant interval increased surrounding edema.A tiny study patient bone in the intrahemispheric aspect of right anterior frontal lobe measures approximately 4 mm in size compared to prior study measurement of approximately 2.5 mm.A necrotic rim enhancing metastatic lesion in the left thalamus measures at 6 x 7-mm compared to prior study measurement of 5 x 5 mm.a superficially located large necrotic enhancing tumor in the left posterior temporal lobe measures at 20.7 x 24 x 20-mm compared to prior study measurement of 14 x 12 x 12-mm. This lesion also demonstrates fairly significant interval increased surrounding vasogenic edema.An enhancing and centrally necrotic metastatic lesion in the pons is again identified and measuring at 5 x 10-mm without surrounding edema or significant change since prior study.Any right inferior cerebellar paramedian metastatic tumor measuring 7 times 6-mm and without interval change since prior study or any significant surrounding edema/mass effect.There is no evidence of any new metastatic lesions.Increased mass effect from a large left posterior temporal metastatic lesion results in only trace deviation of midline to the right which is new since prior exam.Flair hyperintensity of right hemispheric white matter likely representing post treatment/radiation. The white matter of left hemisphere is widely hyperintense secondary to increased peritumoral edema.Calvarium and orbits are unremarkable and without evidence of metastatic lesions.Paranasal sinuses and mastoid air cells are unremarkable.
1.Significant interval increase in size and surrounding vasogenic edema of several of the metastatic brain lesions since prior study.2.View of the smaller metastatic lesions demonstrate no significant change.3.Increased peritumoral edema in particular on the left results in trace deviation of midline to the right which is new since prior exam.