Clinical question: history of metastatic melanoma with multiple brain metastases s/p SRS to L occipital lesion; surveillance exam. Signs and Symptoms: brain mets. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.A right frontal cingulate virus enhancing metastatic lesion measuring at 7.2 x 9.3, 9.9 times mm demonstrates subtle interval increase in size since prior study measurements of 5.4 x 8.4 x 5.9 mm no appreciable surrounding vasogenic edema and with stable nonenhancing cystic-appearing component.A right superior occipital 2.2 mm enhancing metastatic lesion demonstrates subtle interval increase since prior study measurement of approximately 1.7 mm.A left posterior temporal-occipital metastatic lesion measuring at 3.2 x 4 mm demonstrate also subtle interval increased size since prior study measurement of approximately 3.1 x 3.1 mm. There is no surrounding edema or mass effect. No additional new foci of parenchymal or leptomeningeal enhancement since prior exam.Stable cortical sulci, ventricular system and CSF spaces for patient's stated age.A tiny right posterior frontal developmental venous anomaly is again identified and without change since multiple prior exams.A small cyst with very thin rim of enhancement in the pineal cistern remains identical to multiple prior studies.Calvarium and soft tissues of the scalp demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.
1.No acute intracranial process and negative diffusion weighted series.2.Very minimal interval increased size of multiple supratentorial metastatic lesions as detailed/measurement above. No evidence of new metastatic lesions.3.Stable tiny right posterior frontal developmental venous anomaly and a small cyst of the pineal region.4.Unremarkable calvarium, orbits, mastoid air cells and middle ear cavities.5.Stable mild bilateral (right greater than left chronic maxillary sinus disease and unremarkable other paranasal sinuses. 