 Again seen are postsurgical changes of right temporo-parietal craniotomy for resection of metastasis at the right temporo-occipital junction. There are susceptibility changes along the margin of the treatment cavity as well as left temporal lobe, consistent with blood products, unchanged from prior. There is confluent T2 signal changes surrounding the resection cavity in the right temporal and occipital lobes, similar to previous. There is interval increased nodular enhancement along the right temporo-occipital lobe resection cavity with nodular enhancement superiorly and posteriorly to the treated cavity. These changes while may be in part related to posttreatment effects, remain highly suspicious for local tumor recurrence.In addition, there are 2 ring-enhancing lesions measuring 9 mm and 6 mm in the right frontal lobe (series 2401, image100, image 104), with mild associated edema, consistent with metastases. There is an additional focus of enhancement measuring 9 x 7 mm in the right occipital lobe abutting the superior sagittal sinus (series 2401, image 92) compatible with metastasis. Superior sagittal sinus, however, remains patent.There is an apparent focus of enhancement in the right cerebellum (image 9, series 2201) seen on post gadolinium spin echo sequences, which is not seen in other sequences and not associated T2 signal changes, and therefore most likely artifactual.There are a few scattered periventricular and subcortical white matter hyperintensity, which are nonspecific but compatible with mild chronic small vessel ischemic changes, unchanged. There is no significant intracranial mass effect, midline shift or uncal herniation. Normal flow-voids are demonstrated in the major intracranial vascular structures. No destructive lesions in the calvarium are appreciated.
1. Compared to 6/8/2015, there is evidence of progression of metastatic disease. There are two new subcentimeter right frontal and one new right occipital enhancing lesions consistent with metastases. There are also new nodular areas of enhancement along the superior and posterior aspect of the right temporo-occipital resection cavity, which has been recently treated with radiation; while these changes may be in part treatment related, they remain highly suspicious for local tumor recurrence given their nodular appearance and new metastases elsewhere.2. No significant intracranial mass effect associated with the above lesions.