82 years, Female, NSCLC with brain metastasis, status post SRS. Surveillance. Compared to 6/16/2016, there has been mild interval enlargement of enhancing lesion in the left frontal lobe which measures 16 x 17 x 14 mm in the AP, transverse, and craniocaudal dimensions, previously 15 x 13 x 11 mm measured similarly. There is increase in thickness of the peripherally enhancing tissue with central area of necrosis appearing relatively smaller. There is also increase in surrounding vasogenic edema and minimal associated mass effect on the left frontal horn. No significant midline shift or herniation.No new enhancing lesions are definitively appreciated within the limits of mild motion degradation. There is a 4 mm focus of enhancement in the left parietal lobe along the cortical surface adjacent to the intraparietal sulcus, series 1102 image 140, which appears to be present on prior studies although obscured due to motion artifact on multiple prior studies. No evidence of acute ischemia. No large hemorrhage. There are minimal foci of susceptibility associated with the left frontal lobe lesion compatible with microhemorrhage. Again seen are patchy foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with posttreatment-related changes and/or chronic small vessel ischemic disease. Ventricles are normal in size. Calvarium and extracranial soft tissues are grossly unremarkable.
1. Compared to 6/16/2016, there has been mild increase in size of left frontal lobe enhancing lesion. Given history of recent radiation therapy, post treatment change remains a possibility. Tumor progression however cannot be excluded. Consider short-term follow-up with perfusion imaging.2. 4 mm focus of enhancement in the left parietal lobe along the cortical surface adjacent to the intraparietal sulcus is suspicious for an additional punctate metastatic focus. This lesion appears to be present on prior recent studies although not well imaged due to motion degradation.