Urothelial cancer with brain metastases. Status post resection and radiation. Evaluate extent of disease. Motion artifact limits the examination particularly the postcontrast images. Redemonstrated postoperative changes from a left frontal craniotomy and left frontal lobe tumor resection. Compared to the MRI from 10/6/2015, the resection cavity now has a more defined cystic appearance. Marked interval reduction in adjacent vasogenic edema is noted. There remains a thin enhancing rim which may represent granulation tissue. No suspicious masslike or nodular enhancement.The previously identified left temporal lobe metastasis has markedly reduced perilesional edema. No residual enhancing lesion is identified, however the postcontrast images are limited by motion artifact. Immediately medial to the resection cavity within the subcortical white matter is a 7 mm focus of increased T2 signal. This appears to have been present previously, but was largely obscured by the extensive vasogenic edema previously present in this region. No enhancement is noted on postcontrast images. This along with other scattered periventricular and subcortical white matter T2 bright foci likely represent small vessel ischemic changes.The ventricles and basal cisterns are normal in size and configuration. The expected intracranial vascular flow voids are present. The paranasal sinuses are clear. The visualized mastoid air cells are clear. The orbits are unremarkable.
1. Expected evolution of left frontal lobe resection cavity with marked interval reduction in perilesional vasogenic edema. No suspicious residual enhancement to suggest residual tumor.2. Interval reduction in perilesional edema adjacent to the left anterior temporal horn metastatic lesion. No residual enhancement is identified, however motion artifact mildly limits the exam in this region.Artifact from patient motion limits the examination, particularly on the postcontrast images. Performing future imaging with sedation may be useful for improving image quality.