Reason: SRS planning to metastatic resection cavity History: SRS planning to metastatic resection cavity. There has been interval expected evolution of previously seen right sided postoperative changes from previous temporal parietal craniotomy for mass resection. There remains a thin T2 hyperintense extra-axial collection underlying the craniotomy flap, along with mild dural thickening and enhancement. The right periatrial resection cavity appears similar in configuration, measuring 2.1 x 0.9 cm compared to previous 2.3 x 0.8 cm. A rim of hyperintensity remains along the periphery which may represent a combination of nonspecific enhancement enhancement as well as underlying intrinsic T1 signal as precontrast images are not available on the current exam. A focus of T1 hyperintensity is identified extending to the right lateral ventricular margin at the level of the atrium, as seen on 402/170.Surrounding T2 hyperintensity has significantly improved, although remaining present in a faint vasogenic pattern. There is significant improvement in mass effect upon the adjacent right lateral ventricle. The right temporal horn now appears symmetric to the contralateral side. Midline shift is essentially resolved. Overall, susceptibility along the resection cavity margin appears slightly diminished.There is an emerging subtle peripherally enhancing lesion in the right paramedian frontal subcortical white matter on 401/132 in the cingulate gyrus measuring up to 4 mm. There is a small amount of T2 hyperintensity noted in this location.There is mild-moderate fluid opacification of right mastoid air cells.
1. Emerging tiny 4 mm peripherally enhancing lesion along the right frontal cingulate gyrus with punctate T2 hyperintensity which may represent an additional metastatic lesion.2. Interval expected evolution of previously described postoperative changes with similar configuration of a right posterior temporal resection cavity, with nonspecific peripheral hyperintensity on available T1-weighted images. Minimal extension towards the right lateral ventricular margin.3. Significant interval improvement in extent of vasogenic edema and localized mass effect, as well as resolved midline shift.