follow up of previously shown multiple pial enhancing lesions. There is relatively well defined ovoid shaped enhancing nodule on the right cerebellar hemisphere. The size of the lesion is about 7.6mm x 9.2mm. There is minimal surrounding edema on FLAIR images indicating possible metastatic nodule considering the patient's clinical history. Comparing to prior study, the lesion is identifiable but due to significant motion artifacts, it was not clearly appreciable on prior exam. The size of the lesion measured on prior scan is about 6.9mm x 5.3mm. Suspicious but similar nature nodular lesion is also seen on the right insula.Most of previously identified patchy sulcal enhancements including right side parieto-occipital fissure are not seen on today's scan but remains one of unusual subtle enhancements on the right central sulcus caudal aspect.Previously shown patchy cortical high signal intensity on FLAIR images are not seen on today's scan.  The ventricles, sulci and cisterns are symmetric and unremarkable. There is no midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Interval increase in size of the right cerebellar hemispheric enhancing nodule which most likely represent metastatic nodule. A small suspicious nodular enhancement on the right insular could also represent a small nodular metastatic lesion.2. Previously seen sulcal enhancement and cortical high signal intensities on FLAIR are not seen except the left central sulcal lesion indicating interval improvement. 