60-year-old male with renal cell carcinoma, evaluate for metastases. There is a lesion in the right posterior temporal lobe with T2 intermediate signal, diffusion restriction and mild uniform enhancement with a slightly more prominent curvilinear peripheral enhancing component. This lesion measures 1.9 x 1.7 cm (13/133). This lesion contains a punctate focus of susceptibility, which could represent microhemorrhage, however no significant intrinsic T1 shortening or susceptibility is seen. A second lesion with intermediate T2 signal and diffusion restriction and mild uniform enhancement in the left posterior frontal lobe measures 2.0 x 2.3 cm (13/193). Again, no significant intrinsic T1 shortening or susceptibility is seen within this lesion to suggest hemorrhage. Anteriorly, this lesion demonstrates a region of more T2 hyperintense nonenhancing signal which could represent a small cystic component. There are a few punctate foci of increased T2 signal scattered throughout the cerebral white matter without enhancement or mass effect, including a focus in the anterior left frontal lobe, which are nonspecific.The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
1.Enhancing lesions in the right posterior temporal and left posterior frontal lobes likely represent metastasis. No MRI findings of significant internal hemorrhage are seen. Hyperattenuation on prior CT likely reflected high cellularity.2.A few punctate foci of increased T2 signal are nonspecific but may be related to chronic small vessel ischemic disease.