Male, 53 years old, status post stereotactic radiosurgery for brain metastases with increased enhancement of a cerebellar lesion on the most recent exam. A 6 mm enhancing lesion within the left anterior cerebellum has not significantly changed in size since. The lesion demonstrates internal susceptibility effect which has gradually increased over multiple prior examinations, possibly representing slow accumulation of hemosiderin. Surrounding T2 hyperintensity compatible with vasogenic edema is stable to at most minimally more extensive when compared to the immediate prior study.An oval, T2 hyperintense lesion with minimal if any rim enhancement is redemonstrated in the left frontal lobe showing no significant interval change in size. There is no edema surrounding this lesion. A punctate focus of enhancement within the left intraparietal sulcus is unchanged. No new enhancing lesions are seen. Scattered punctate foci of FLAIR hyperintensity are unchanged, for example, along the cortex in the left frontal lobe, right precentral gyrus and left occipital lobe, possibly related to prior treated lesions. No evidence of significant generalized mass effect is seen. Ventricular size and morphology are within normal limits.
1.An enhancing lesion within the left anterior cerebellum shows no significant interval change in size when compared to the immediate prior study. Edema surrounding this lesion, although clearly more extensive when compared to older exams, is stable or at most minimally more extensive when compared to the prior study. Given the interval stability of the enhancing component, and the fact that this lesion shows evidence of progressive hemosiderin accumulation over the prior several exams, the edema could be related to treatment effect and mild intralesional hemorrhage. Continued close follow-up is suggested.2.A lesion in the left frontal lobe and a punctate enhancing focus within the left intraparietal sulcus are unchanged. No new enhancing lesions are seen. The remainder of the examination is unchanged.