Clinical question: Metastatic lung cancer with previous resected right cerebellar metastases. Signs and symptoms: As above. Pre and post enhanced brain MRI:No diffusion-weighted abnormalities.Examination demonstrates interval increased size of a large necrotic rim enhancing tumor in the right para median cerebellum. On the current exam the tumor measures at least at 26 x 26 mm in transaxial dimensions compared to prior study measurement of 16.5 x 21.5 mm. On sagittal post enhanced series the tumor measures 22 x 26 mm compared to prior study measurement of 15 x 18 mm. There is extension of tumor into the vermis on the right. Surrounding vasogenic edema results in subtle mass effect on the fourth ventricle with anterior direction flattening. The fourth ventricle however remains patent.Although not a dedicated exam there is significant improvement of extensive region of enhancement with internal foci of hypoenhancement in the soft tissues of suboccipital region since prior exam. Recommend follow-up with dedicated pre- and post enhanced soft tissues of neck MRI for more complete assessment.There is no convincing evidence of any additional metastatic lesions on this degraded post enhanced images secondary to motion and extensive pulsation artifact.Ventricular system remains within normal size and with maintained midline without change.Calvarium is negative for metastatic lesions.Unremarkable images through the orbits and including axial fat sat post enhanced series.
1.Interval increased size of a right cerebellar enhancing/necrotic metastatic lesion measuring at 26 x 26 mm compared to prior study measurement of 16.5 x 21.5 mm. Mild increased surrounding edema and mass effect.2.Significant interval decreased enhancement of the limited visualized soft tissues of suboccipital region since prior study. Further follow-up with dedicated pre and post enhanced neck MRI is recommended for assessment of tumor.