66 years, Female, history of brain metastases.. Again seen are multiple supra and infratentorial enhancing lesions consistent with known metastatic disease. Most of these lesions demonstrate no significant change in size or appearance allowing for slight differences in technique and measurement. There is however an enhancing lesion along the left central sulcus which measures 12 x 13 mm, previously 9 x 9 mm and also now appears more contiguous with the dural surface and with slightly irregular borders. There is mild associated increase in vasogenic edema in the left posterior frontal and anterior parietal lobe. Small enhancing lesion involving the central sulcus more inferiorly measures 5 mm and not significant changed. Left basal ganglia lesion previously 9 x 8 mm now measures 10 x 9 mm. Multiple bilateral cerebellar enhancing lesions are not significantly changed. Small left-sided subdural collection demonstrates slight evolution and slight decrease in size.Again seen are postoperative changes related to left parieto-occipital craniotomy. Background of confluent T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter is similar to prior and compatible with chronic small vessel ischemic disease and/or posttreatment-related changes. Encephalomalacia in the left cerebellar hemisphere is again seen. Developmental venous anomaly in the brainstem and associated focus of susceptibility compatible with cavernous reformation again seen. Additional foci of susceptibility related to microhemorrhage in the cerebellum are also not significantly changed including few foci which appeared to be associated with the enhancing right cerebellar metastatic lesions but similar to immediate prior. No evidence of acute infarct. Ventricles are stable in size. No midline shift or uncal herniation. Minimal mucosal thickening in the paranasal sinuses and minimal fluid in the bilateral mastoid air cells again seen.
Compared to 1/27/2016, there has been overall no significant change in the size or number of the multiple supra and infratentorial enhancing lesions related to known metastatic disease. There is however a particular left frontoparietal lesion along the left central sulcus which demonstrates slight enlargement, irregular margins, increased contiguity with the overlying dura, and with slightly increased surrounding vasogenic edema. This finding may be related to posttreatment change or perhaps slight progression of this lesion.