46 years, Male, lung cancer. Please note comparison with outside MRI from 3/1/2016 is slightly limited due to limited sequences on prior study. Again seen are innumerable foci of intracranial metastatic disease with susceptibility indicating hemorrhage. There are at least 10 enhancing lesions which are evident involving the bilateral cerebral hemispheres as well as few punctate lesions involving the cerebellar hemispheres. Some of the hemorrhagic foci do not definitively demonstrate enhancement and may represent treated metastases.A relatively large right frontal lobe peripherally enhancing mass measures approximately 22 x 20 x 26 mm, previously measured approximately 21 x 15 x 22 mm. A right paramedian right parietal lesion measures 16 x 16 x 16 mm, previously 14 x 14 x 13 mm. A bilobed enhancing mass involving the left central sulcus measures approximately 18 x 13 mm in the craniocaudal and transverse dimensions in the coronal plane, previously 13 x 12 mm, measured similarly. There is decrease in central enhancement suggesting necrosis or treatment change. A punctate left lateral cerebellar enhancing lesion is not significantly changed. There is a punctate right cerebellar hemispheric lesion which was present on prior and not clearly enhancing on the current study. No new lesion is appreciated.Prior outside exam was obtained with limited sequences however there is increased FLAIR hyperintensity compatible with vasogenic edema associated with the relatively large right frontal, right parietal, and left central sulcus lesions. No evidence of midline shift or herniation. No hydrocephalus. No destructive calvarial lesions.There is a fluid collection in the left suboccipital scalp measuring approximately 11 x 10 mm, corresponding to a pin site of the prior stereotactic frame. There are surrounding inflammatory changes. There is central restricted diffusion which can be seen with pus.
1. Again seen is evidence of intracranial metastatic disease with multiple, predominantly supratentorial enhancing lesions. Compared to most recent MRI brain dated 3/1/2016 with limited sequences, there is mild enlargement of some of the lesions and, more significantly, increased surrounding vasogenic edema which may represent posttreatment change, although progression is not excluded. Suggest continued close follow-up. No new lesion is definitively appreciated. Please see details above.2. Susceptibility-weighted sequence demonstrates numerous foci of chronic hemorrhage, many of which correspond to the enhancing foci described above. The nonenhancing foci may represent treated metastases.3. 11 x 10 mm fluid collection with peripheral enhancement and surrounding edema in the left suboccipital scalp region, which appears to represent a pin site for prior stereotactic frame. Imaging features are highly suggestive of abscess, but suggest correlation with examination.