60 year-old female with renal cell carcinoma with brain metastases and change in mental status. Evaluate for edema, hemorrhage, and additional metastases. Right parietal shunt catheter with tip lying in the midline of lateral ventricles is unchanged. Completely collapsed the right lateral ventricle and prominent left lateral ventricle are unchanged. Remaining ventricles are unremarkable.Two midline, hyperattenuating lesions in superior suprasellar cistern are reidentified and consistent with hemorrhagic metastases. Larger more anterior lesion is now more heterogeneous in appearance and measures 12.4 x 12 .3 mm, previously measured 11.7 x 13.2 mm. Mild interval enlargement of smaller posterior lesion measuring 6.4 x 7 .3 mm, previously measured 5.4 x 5.9 mm. There has been interval enlargement and increased heterogeneous attenuation of prominent pineal gland measuring 12.4 x 7 .8 mm, previously measured 10.9 x 5.9 mm (series 3, image 14).Right cerebellar hemisphere hypoattenuation consistent with vasogenic edema secondary to metastatic focus seen on most recent MRI.Region of encephalomalacia in the right superior frontal gyrus is unchanged.There is no evidence of intracranial hemorrhage, mass or edema. Postsurgical changes in the frontal bone and right parietal catheter. Otherwise, the calvaria and skull base are radiographically normal. The visualized paranasal sinuses and mastoid air cells are normally pneumatized.
1. Prominent, heterogeneous pineal gland with mild interval enlargement that could be related to difference in technique between the current and previous scans or could represent underlying lesion. MRI is recommended for better evaluation if clinically indicated.2. Two partially hemorrhagic suprasellar cistern region metastases, with mild increase in size. 3. Hypoattenuation in right cerebellar hemisphere consistent with vasogenic edema from small metastatic focus seen on recent MRI.4. No acute intracranial abnormality.