Clinical question: 87-year-old female with metastatic SCC of esophagus status post SRS to the left posterior central lesion, evaluate other metastatic lesions for progression. SRS planning. Signs and symptoms: None. Pre and post enhanced Stealth brain MRI:Examination is performed utilizing stealth protocol for treatment planning and is not a complete diagnostic exam.Examination demonstrate interval increased size and internal necrosis of a previously noted metastatic lesions in the right postcentral gyrus measuring at approximately 9 x 9 mm in transaxial dimensions compared to prior study measurement of 4 mm. This lesion also demonstrates new surrounding vasogenic edema with very subtle regional mass effect. There is a second smaller enhancing carotic metastatic lesion at this site measuring approximately 5 x 6 mm in transaxial dimensions compared to prior study measurement of approximately 3.5 mm.Interval increased size, necrosis and new surrounding vasogenic edema of a left posterior parietal single gyrus measuring approximately at 9 x 13 mm compared to prior study measurements of approximately 5 x 3 mm. This lesion results in subtle regional mass effect. There is however interval decreased size of a metastatic lesion in the left precentral gyrus since prior exam measuring approximately 5.5 x 3 mm.No convincing evidence of new metastatic lesions.No detectable calvarial abnormal enhancement/metastases.There is revisualization of a small left posterior temporal-parietal developmental venous anomaly..
Examination demonstrate interval increased size, internal necrosis and new vasogenic edema of previously known mets since prior exam as detailed/measured above.