 The evaluation is limited due to the lack of contrast.There is stable extensive left occipito temporoparietal confluent vasogenic pattern hyperintensity on T2 and FLAIR. There is vasogenic pattern T2/FLAIR hyperintensity in the right parietal white matter, also similar to the prior exam. The lesion that was noted in the previous study in the posterior left cingulate gyrus, which has a low T2/FLAIR intensity rim and a center that is isointense to the white matter, is stable and is unchanged in size. Currently it measures 18 x 19 mm. On the susceptibility-weighted images, hemosiderin rim is seen associated with this lesion. The posterior left lateral ventricle remains effaced by localized mass effect. There is midline shift of approximately 6 mm, unchanged from the previous study.Since the prior exam there is interval increase in the extent of the FLAIR hyperintensity associated with the right superior temporal gyrus lesion, the lesion measuring 3 x 4 mm (501/21).The previously not measurable lesion in the right inferior temporal gyrus currently measures 4 x 4 mm with associated increase in the extent of the surrounding FLAIR hyperintensity.Medial to the left temporal horn is now a discrete lesion that measures 11 x 15 mm with increased surrounding edema.There is unchanged right cerebellar hemispheric encephalomalacia. The flow voids of the major intracranial vascular structures are within the normal limits. Ventricular size is stable.There is old lamina papyracea fracture. Fluid is seen in the right mastoids.
1. Progression of the metastatic lesions that was seen in the previous study in the right temporal lobe.2. Interval emergence of new metastatic lesion in the left temporal lobe with increased extent of vasogenic edema.3. The metastatic lesion that was seen in the previous study in the posterior aspect of the left cingulate gyrus is stable, with similar degree of localized mass effect and midline shift.