55 years, Male, metastatic lung cancer with history of brain metastases. Additional history per chart, patient has history of gamma knife, whole brain radiation, and chemotherapy. Again seen are multiple enhancing lesions in the brain consistent with known intracranial metastases.The right temporal enhancing lesion, axial image 99, measuring 18 x 14 mm is not significantly changed. 4 mm focus of enhancement in the left thalamus not definitively seen previously and appears new. A 3 mm enhancing lesion involving the right cingulate gyrus, axial image 181, not clearly seen on the immediate prior but appears present on 7/10/2015. Multiple foci of enhancement along the cortex in the left posterior frontal lobe, such as axial images 240 and 227 are grossly similar to prior allowing for slight differences in technique although a 2 mm lesion, axial image 209 appears more conspicuous.Enhancing lesion in the left paramedian cerebellum measures 10 x 7 mm, image 78, is not significantly changed. There are 2 subcentimeter enhancing lesions in the left cerebellar hemisphere, axial image 52; the more anterior one measures 3 x 5 mm, previously 2 x 3 mm; the more posterior punctate lesion is not significantly changed. A punctate right cerebellar enhancing nodule, image 74, not significantly changed.There is patchy FLAIR hyperintensity throughout the bilateral supratentorial white matter which is gradually increased across prior studies from 3/14/2016 and 7/20/2015 and likely represents posttreatment change. FLAIR signal associated with some of the lesions such as in the right temporal lobe similar to prior. There may be slight increase in FLAIR signal abnormality associated with the left paramedian cerebellar lesion. No evidence of acute ischemia. There are foci of susceptibility effect such as in the right temporal lobe and left cerebellum associated with the lesions compatible with blood products. These are not evident on prior outside gradient sequences which were acquired with a less sensitive technique and therefore not necessarily new.No significant intracranial mass effect, midline shift, or herniation. No hydrocephalus.In review of the earlier study from 7/10/2015, there are multiple enhancing lesions such as in the left and right aspect of the pons which are no longer present.
1. Multiple foci of supra and infratentorial intracranial metastatic disease some of which appear new or slightly larger when compared to 3/14/2016. Please see details above.2. No significant intracranial mass effect associated with the lesions.