Clinical question: Planning for SRS. Signs and symptoms: Left-sided weakness. Pre and post treatment planning brain MRI:Examination demonstrates an enhancing intra-axial right high convexity superior frontal gyrus metastatic mass measuring at 19.5 x 19.5 x 17.5 mm with slight interval increased size since prior exam from 4-2-15. Extensive surrounding vasogenic edema results in regional mass effect.There is no detectable additional parenchymal or leptomeningeal enhancement.Since prior MRI exam a large left anterior frontal bone enhancing metastatic lesion has been surgically removed and without evidence of recurrence on this limited exam (surgical planning study and not a true diagnostic MRI).Additional small calvarial 5/4/2015 lesions without definitive interval change since prior exam are again noted. Ventricular system remains within normal size and with maintained PICC line. Periventricular white matter Flair hyperintensity (right greater than left) consistent with residual edema, treatment changes as well as overlapping chronic small vessel ischemic strokes are again noted.
1.Right superior frontal gyrus metastatic lesion measuring 19.5 x 19.5 x 17.5 mm and with slight interval increased size since prior exam.2.Interval removal of left anterior frontal skull metastatic lesion.3.Stable multiple additional small calvarium metastases.