Reason: pt with met melanoma on chemo please assess response to therapy and compare to previous imaging History: met melanoma. There are multiple new and enhancing lesions throughout the brain, likely representing progression of metastases, including lesions in the bilateral frontal lobes, right posterior parietal lobe, head of the left caudate and bilateral cerebellum. Some of these lesions have increased intrinsic T1 signal and susceptibility which may represent melanin or blood products. Other lesions have only increased susceptibility, likely hemorrhage. A left occipital lobe lesion seen previously is unchanged in size measuring 5 mm. Additional lesions seen previously are slightly enlarged and, as above, multiple new punctate lesions are present throughout the supratentorial parenchyma. There is a minimal amount of edema surrounding some of these lesions. Hemosiderin deposition along the left frontal lobe sulcus is stable. There are also new enhancing lesions involving the right inferior rectus, right superior oblique and left superior rectus which likely represent metastases.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. Pineal cyst is unchanged. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Progression of intracranial metastatic disease with multiple new metastatic lesions within the brain parenchyma and involving the extraocular muscles bilaterally.