Metastatic cancer to the brain. Treatment planning. Punctate residual contrast enhancement in the left cerebellar hemisphere related to treated lesion is unchanged. There are several contrast enhancing nodules involving the left parietal and occipital white-matter, which appears slightly increased in size since the previous examination. The largest one measures 7 mm compared to 5 mm previously, and is in the left parietal lobe. On the axial 3D postgadolinium series 1201, there are two left parietal lobe lesions, images 123 and 118. There is a left temporal occipital lesion, image 89. Lesions are associated with minimal surrounding edema, which is increased. Given their size, there is no significant mass-effect. There are questionable additional foci of enhancement such as in the right anterior temporal lobe, axial image 78 and right frontal lobe image 138, possibly artifactual. The significance of these may be better assessed on follow-up studies.There is no midline shift or brain herniation. There is no acute intracranial hemorrhage or infarct. The major vascular flow voids are preserved. There is mild mucosal thickening in the anterior ethmoid sinuses and right maxillary sinus. There is no gross orbital abnormality.
1.There are at least 3 well-defined subcentimeter enhancing lesions involving the left parietal lobe and at the left temporal-occipital junction as described above, which are consistent with metastatic disease. There is minimal surrounding edema.2.Punctate residual contrast enhancement in the left cerebellar hemisphere related to treated lesion is unchanged. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.