68 years, Female, clear cell renal carcinoma status post right radical nephrectomy in 2014 with brain metastases. Evaluate for radiosurgery planning. Examination is obtained for treatment planning and limited to postgadolinium 3D T1 and VENBOLD sequences. There are multiple small enhancing lesions including the left middle frontal gyrus (series 401, image 126), relatively large lesion in the right parietal lobe, left parietal lobe involving the superior parietal lobule (series 401, image 120), right occipital lobe, and left cerebellar hemisphere (series 41, image 38), many with associated susceptibility, compatible with hemorrhagic metastases. The largest lesion is located within the right posterior parietal lobe measuring up to 1.6 x 1.2 cm. There is associated right parietal, right occipital, and left cerebellar vasogenic edema, relatively greater within the right parietal lobe. There is no midline shift or herniation. There are few additional foci of susceptibility without corresponding enhancement, likely related to previously treated metastases. The ventricles are within normal limits in size and configuration. There is no extra-axial collection. Bone marrow signal and extracranial soft tissues are grossly unremarkable.
1. At lease 5 intraparenchymal enhancing lesions in the brain including the left frontal lobe, right and left parietal lobes, right occipital lobe, and left cerebellum, compatible with metastases. Some of these lesions demonstrate susceptibility effect consistent with hemorrhage. Vasogenic edema is associated with some of the lesions, particularly in the right parieto-occipital lobes, without midline shift or herniation. 2. Several foci of susceptibility effect without corresponding enhancement presumably representing previously treated metastases.Please note examination is limited to sequences for treatment planning and prior complete brain MRI is not available for comparison.