 Again demonstrated are posttreatment changes related to surgical resection of left occipital lobe mass with associated susceptibility effects related to blood products. There has been interval increase in heterogeneous contrast enhancement in the left occipital lobe with a more focal mass-like area involving the left paramedian occipital lobe with associated restricted diffusion, overall measuring 2.2 x 1.7 cm. Much of the surrounding enhancement is favored to represent radiation related changes as seen previously. Perfusion images demonstrates elevated cerebral blood volume within the medial aspect of the left occipital lobe. There is extensive T2 FLAIR hyperintensity surrounding the left occipital lesion extending into the left parietal lobe superiorly and the left posterior temporal lobe, mildly progressed since prior. There is slight interval enlargement of the lateral ventricles predominantly left occipital lobe. There is mild rightward midline shift.Additional new rounded, rim enhancing lesion with internal punctate heterogeneous enhancement measuring 1.4 x 1.3 cm is seen along the posterior aspect of the right medial orbital gyrus. There is mild surrounding T2 hyperintensity suggesting vasogenic edema. There is another enhancing lesion measuring 0.7 x 0.5 cm in the right post central gyrus with surrounding edema (image 38, series 15).
1.Extensive posttreatment changes in the left occipital lobe related to prior surgery and radiation. Compared to 3/2/2015, there is interval increase in more masslike area of enhancement in the left paramedian occipital lobe measuring approximately 2.2 x 1.7 cm with elevated CBV and suspicious for tumor recurrence. Much of the surrounding enhancement is likely reflective of radiation change as seen previously. Mild interval increase in surrounding edema.2. Two new enhancing lesions involving the right inferior frontal lobe and the right parietal lobe (post central gyrus) consistent with progression of metastatic disease.