Clinical question: History of MS and metastatic renal cancer, status post SRS to cerebellar metastases. Assess for progression. Signs and symptoms: None Pre and post enhanced brain MRI:Examination redemonstrate an irregular hemosiderin laden focus of enhancement in the right posterior parietal lobe without appreciable change in its size (20 x 22 x 22 mm), morphology or extent since prior exam. The enhancement however appears less intense and with suggestion of increased internal necrosis. This finding is associated with subtle mass effect on the trigone and posterior body of right lateral ventricle similar to prior study.Examination also redemonstrate an enhancing mass in the superior (median vermis with interval increase internal necrosis and increased size. Increased size could represent pseudo progression secondary to necrosis. Follow-up exams however are recommended. This lesion measures approximately 16 x 10 x 13 mm compared to prior study measurements of 15 x 8 x 9 mm. Associated surrounding FLAIR hyperintensity consistent with edema remains fairly similar to prior exam.There are no detectable new foci of parenchymal or leptomeningeal enhancement.Fairly extensive FLAIR hyperintensity of bilateral hemispheric white matter consistent with posttreatment changes are again noted.Calvarium is unremarkable.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.Treated metastatic lesion in the right posterior parietal demonstrate no significant change in size however there is mild further increase in internal necrosis as detailed.2.Vermian metastatic lesion demonstrates subtle interval increased size and internal necrosis as detailed/measured above. Increased size may represent pseudo progression secondary to internal necrosis.3.Stable diffuse FLAIR hyperintensity of bilateral hemispheric white matter, ex vacuo dilatation of the supratentorial ventricular system however with maintained midline.