Metastatic renal cell carcinoma. Status post resection and radiation treatment. Assess brain metastasis. There are changes related to left frontal tumor resection and hematoma evacuation. The surgical bed has not changed, including changes of laminar necrosis as well as T1 shortening, susceptibility effect and focal diffusion restriction related to the presence of blood products. The adjacent parenchymal T2-hyperintensity is largely unchanged except for slight increased conspicuity of extension along the anterior limb of the left internal capsule, which may reflect differences in technique as today's examination was acquired on a 3 Tesla magnet. There is further decreased prominence of areas of nodularity and essentially resolved enhancement in the left frontal lobe resection cavity. This is favored to represent evolving postoperative change. There is no significant change in the other posttreatment findings and there is no new or suspicious contrast enhancement. Associated minimal volume loss is unchanged. The remainder of the brain is notable for unchanged punctate T2 hyperintensities in the cerebral white-matter that reflect chronic microvascular ischemia. There is no new brain abnormality. The ventricles and sulci remain unchanged, accounting for mild central volume loss. Major intracranial vascular flow voids are preserved.Mucosal thickening in the maxillary and ethmoid sinuses remains mild and not significantly changed.There are postoperative skull and scalp changes related to previous left frontal craniotomy. There is no destructive skull lesion.There is susceptibility effect related to the previous posterior C1-C2 surgery.
1.Further decreased prominence of nodularity and enhancement in the left frontal resection cavity suggesting evolving postoperative changes, without findings concerning for tumor recurrence.2.There is no new brain contrast-enhancing lesion.