SRS with progression of right superior frontal gyrus lesion status post laser treatment and untreated right occipital lesion. There are post-treatment findings related to laser ablation of a right superior frontal gyrus that measures up to approximately 15 mm, which has not significantly changed. However, there appears to be decreased enhancement within the mass. However, there is an intermediate to high T1 signal area with surrounding edema anteroinferior to the mass, measuring up to 25 mm, as well as a punctate nodular T1 hyperintensity inferior to this. There is also subarachnoid hemorrhage in the anterior parafalcine region. There is no significant interval change in size of the nodules within the bilateral occipital lobes and right precentral gyrus lesion. There is no midline shift or herniation. The ventricles and basal cisterns are normal in size and configuration. The skull, orbits, and scalp soft tissues are unchanged.
1. Post-treatment findings related to laser ablation of a right superior frontal gyrus that measures up to approximately 15 mm, which has not significantly changed. However, there appears to be decreased enhancement within the mass, which may be due to necrosis from treatment effects.2. Predominantly T1 hyperintense area anteroinferior to the right superior frontal gyrus mass, measuring up to 25 mm may represent an acute to subacute hematoma with surrounding subarachnoid hemorrhage, although development of an underlying hemorrhagic tumor is potential consideration. Furthermore, a punctate nodular T1 hyperintensity inferior to this, may represent and additional focus hemorrhage, tumor, or possibly a pseudoaneurysm. Assessment is limited on this treatment planning MRI and dedicated brain MRI and MRA may be useful for further evaluation.3. Other subcentimeter intracranial metastases are unchanged.