History of brain metastasis. Interval evolution of postsurgical changes is seen related to left parietal craniectomy for resection of metastatic calvarial lesion. Cranioplasty with titanium mesh again noted. There is small focus of T1 hyperintensity and enhancement at the inferomedial margin of the craniectomy defect which was present on prior from 4/6/2015 and nonspecific. No residual tumor within this location is definitively appreciated. Brain parenchyma demonstrates no evidence of infarct, hemorrhage, mass, or abnormal enhancement to suggest intraparenchymal metastatic disease. Ventricles are within normal limits without evidence of hydrocephalus. Major flow-voids are preserved. Unchanged punctate focus of enhancement in the left frontal calvarium, coronal post gadolinium series 1102 image 26.
1. Evolution of postsurgical changes of left parietal craniectomy and cranioplasty without evidence of tumor progression/recurrence at this site. Unchanged punctate foci of enhancement adjacent to the inferior medial margin of the craniectomy defect which is nonspecific. Unchanged punctate focus of enhancement in the left frontal calvarium which may represent an additional metastatic osseous lesion. 2. No intraparenchymal metastatic lesion is appreciated. No evidence of intracranial mass effect.