Reason: h/o HNC and CRT, s/p RT to brain History: post RT imaging Prior recent brain MR studies have been motion degraded which limit comparison. There are multiple subcentimeter enhancing lesions consistent with metastatic disease. For example there is a 4 x 5 mm left parietal lesion, a 6 x 6 mm right temporal lesion abutting the right temporal horn and a 5 x 4 mm right cerebellar lesion. The left parietal and right temporal lesions are minimally larger since 8/15/2016. There is mild associated edema, which appears slightly increased in the interval associated with the right temporal lesion. Left occipital lesion seen on prior MRI from 8/15/2016 has decreased in size measuring 2 to 3 mm, previously 7 mm in the sagittal plane. A punctate right temporal enhancing lesion seen slightly inferior lateral to a larger lesion on 8/15/2016 is no longer evident.There is a larger heterogeneously enhancing mass involving the occipital scalp which measures approximately 20 x 43 mm in the AP and transverse dimensions previously approximately 14 x 41 mm. There is also greater central nonenhancement suggesting necrosis. There is also an 11 x 12 mm enhancing lesion involving the paraspinous musculature posterior to the right C3 lamina, not seen previously.Previous seen masslike lesion surrounding and possibly invading the posterior aspect of the superior sagittal sinus is markedly decreased in size. Occlusion of the posterior aspect of the superior sagittal sinus remains but appears improved. Asymmetric increased enhancement involving the right cavernous sinus is similar to prior and nonspecific. There is no new lesion to definitively suggest progression of metastatic disease.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No midline shift or herniation. No hydrocephalus. Significant volume loss involving the cerebellar vermis and to lesser degree cerebellar hemispheres again seen.
1. Intracranial metastatic disease demonstrates no clear evidence of interval progression. Enhancing mass involving the distal aspect of the superior sagittal sinus is markedly decreased since 8/15/2016 although there remains short segment occlusion involving the distal superior sagittal sinus. Previously seen adjacent left occipital parenchymal lesion has also significantly decreased in size. A punctate right temporal lesion is no longer perceptible.2. Subcentimeter left parietal and right temporal lesions are minimally larger since 8/15/2016 with also mild increase in edema associated with the right temporal lesion. These findings may represent posttreatment change but suggest continued close follow-up. Right cerebellar enhancing lesion is not significantly changed.3. Large occipital scalp metastases is mildly larger with increased central heterogeneous enhancement suggesting necrosis. There is also a new paraspinous soft tissue metastasis posterior to the right C3 lamina.4. Atrophy involving the cerebellum vermis and to a lesser extent cerebellar hemispheres again evident.