Male, 57 years old, with brain metastases, on new therapy, surveillance exam. Numerous supratentorial and infratentorial enhancing lesions are redemonstrated. Since the prior exam, most of these lesions have decreased in size by several millimeters. For example, a left insular lesion now measures up to 6 mm, previously 8 mm. The large right parietal-occipital lesion has changed in shape, which may reflect collapse of the necrotic components, and despite appearing more elongated in the axial plane, has probably also decreased in size. The edema surrounding this lesion, and several others, has significantly increased, however. The right ventricular atrium is progressively effaced. There is a mild leftward midline shift, but no brain herniation. No new or growing lesions are seen. Evidence of prior right frontal instrumentation is seen. A small scalp lipoma is unchanged.
Interval decrease in size of most of the numerous brain metastases is seen. A few lesions are unchanged in size, but there are no new or growing lesions. Several lesions, including the dominant right parieto-occipital lesion, show progressive edema which is favored to be a treatment effect. 