63-year-old male with history of brain metastasis. Evaluate for progression. There is a new intraparenchymal lesion measuring 2.0 x 1.5 cm within the peripheral aspect of the left cerebellar hemisphere demonstrating heterogeneous enhancement as well as components of diffusion restriction and hemosiderin staining with surrounding vasogenic edema most compatible with metastasis. There are additional smaller enhancing lesions located at the grey-white junction along the right cingulate sulcus, and within right occipital lobe, measuring 5 mm and 8 mm respectively with increased adjacent T2/FLAIR signal abnormality. These lesions are most compatible additional metastatic deposits.There are postoperative findings related to right parietal craniotomy with a right parietal lobe resection cavity containing chronic blood products with additional mild surrounding non-masslike and ill-defined enhancement. Adjacent vasogenic edema has significantly decreased when compared to the prior exam. These findings are favored to represent granulation tissue/post surgical changes, though continued follow up is required to ensure stability or continued regression.Additionally, scattered areas of T2/FLAIR hyperintensity within the periventricular white matter are thought to represent stable chronic small vessel ischemic disease.The basal cisterns are intact. Flow-voids are present within the major cerebral vessels. There is no evidence of abnormal leptomeningeal enhancement. The soft tissues of the scalp are unremarkable. The orbits, paranasal sinuses, and mastoid are cells are clear.
1.New lesion within the left cerebellar hemisphere compatible with metastatic disease. Additional smaller lesions are located along the right cingulate sulcus and right occipital lobe also likely represent additional metastatic foci.2.Postsurgical changes of right craniotomy as above with ill-defined enhancement and decreased surrounding vasogenic edema which is thought to represent granulation tissue/post-surgical changes, although continued followup is recommended.3.Stable-appearing chronic ischemic small vessel disease.