57 years Male (DOB:6/9/1958)Reason: MRI treatment planning prior to stereotactic radiosurgery History: nonePROVIDER/ATTENDING NAME: STEVEN J CHMURA STEVEN J CHMURA The CSF spaces are appropriate for the patient's stated age with no midline shift. Since the prior exam a right frontal LASER ablation probe has been removed.There is a heterogeneous and round mass present in the right frontal lobe periventricular white matter which measures approximately 22 x 20 mm axial dimensions. Enhancement predominantly occurs along the periphery. There are foci of susceptibility long the periphery of the lesion. There is redemonstration of a lesion centered in the left posterior pons associated with susceptibility effect measuring approximately 6 x 7 mm axial dimensions which is also associated with a ring enhancement pattern.There are periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images. This is not substantially changed relative to prior examsThere are multiple punctate subcortical foci of signal loss identified on susceptibility imaging located in both hemispheres as well as the cerebellum. Some of these are associated with contrast enhancementNormal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is redemonstration of a right periventricular frontal partially hemorrhagic mass. This patient is known to have metastatic disease from RCC. Most likely this represents metastasis.2.There is redemonstration of a left pontine hemorrhagic mass. This patient is known to have metastatic disease from RCC. Most likely this represents metastasis.3.There are multiple microhemorrhages scattered in both hemispheres as well as in the cerebellum. Some of these are associated with contrast enhancement and some are not. It is suspected that these represent metastatic disease.4.There are periventricular confluent white matter signal changes which could be treatment related.