Reason: renal cell carcinoma s/p resection and SRS (07/2014) and whole brain radiation 12/2014 History: eval for extent of disease Redemonstration of a treated mass adjacent to the trigone of the left lateral ventricle measuring 2.1 x 1.8 cm (series 501 image 20), previously 2.0 x 2.0 cm, with susceptibility artifact. Wall thickness of this lesion measures approximately 4 mm. Previously this lesion showed intrinsic peripheral T1 hyperintensity without significant additional enhancement. On the current exam it retains intrinsic peripheral T1 hyperintensity, but on postcontrast images there appears to be increased enhancement around the margin. A right parietal lesion measures 6 mm (series 501 image 18), previously 7 mm, with susceptibility artifact. There are stable additional foci of susceptibility artifacts in the left occipital lobe and tiny focus of susceptibility artifact in the right occipital lobe at the sites of prior lesions. Stable postoperative changes of the right frontal lobe resection bed with adjacent susceptibility artifacts. Minimal curvilinear enhancement near the resection site is stable and likely postsurgical. Progressive bilateral periatrial FLAIR signal intensity is seen. No new mass effect or masslike intracranial lesions are detected.There is a new tumor deposit in the left masticator space measuring 1 cm (series 501 image 6). Right maxillary mucous retention cyst. Partial opacification of mastoid air cells bilaterally. Orbits are intact. Normal opacification of the intracranial vasculature and venous drainage.
1.Mild increase of rim enhancing component of the dominant left parietal lesion, of uncertain clinical significance. This may represent post radiation effect or slow tumor growth. In association with this, there is progressive bilateral periatrial white matter signal abnormality, which given symmetric appearance, is favored to represent postradiation effect.2.Right frontal resection bed and other treated parenchymal lesions are unchanged.3.New 1 cm left masticator muscle tumor deposit.