 This exam is limited by motion artifact. There is no evidence of acute infarct. There is an enhancing lesion within the right cerebellar hemisphere that measures 11 x 6 mm, previously 5 x 6 mm, and contains a small unchanged focus of susceptibility effect. There is an unchanged sellar and suprasellar mass that invades the clivus and measures approximately 17 x 15 mm. It is predominantly left sided with an asymmetric thick left cavernous sinus and possible contiguity of the mass into the left cavernous sinus on coronal T2W images, although postcontrast coronal imaging is limited. There is new diffuse pial enhancement, including enhancement along the bilateral posterior intraorbital optic nerves, bilateral seventh and eighth nerves, and possibly the bilateral third and fifth cranial nerves.The internal carotid flow voids are grossly intact. There are multiple rounded foci of T2 hyperintensity throughout the supratentorial white matter that have somewhat decreased in both size and number. The ventricles are slightly increased in size. For example, lateral ventricles measure 35 mm in transverse dimension, previously 32 mm, and the third ventricle measures 8 mm in transverse dimension, previously 6 mm. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the bilateral mastoid air cells.
1.Motion limited exam. 2.New diffuse pial enhancement, including along the bilateral optic nerves, bilateral seventh and eighth nerves, and most likely along the bilateral third and fifth cranial nerves, is most likely neoplastic in etiology. 3.Grossly unchanged sellar and suprasellar mass with clival invasion that cannot be separated from the left cavernous sinus. 4.Increase in size of the right cerebellar metastasis. 5.Decrease in size and number of the supratentorial T2 hyperintense non-enhancing white matter lesions that are most likely treatment related. 6.Slight increase in ventricular size, either due to early communicating hydrocephalus secondary to the leptomeningeal disease and/or treatment related volume loss. Close follow-up is recommended. These findings were called by Dr. Michael Rozenfeld to Dr. Anjali Gera at on 3/20/2015 1:10 PM.