Clinical question: History of metastatic colon cancer with brain metastases. Please evaluate for stereotactic radiosurgery planning. Signs and symptoms: Brain metastases. Pre-and post enhanced treatment planning brain MRI:Enhancing necrotic tumor in the right posterior lateral cerebellar measuring 20.7 x 18.0-mm with interval increased size since the prior study measurement of 13.5 x 10-mm with surrounding vasogenic edema and regional mass effect.A large irregular necrotic rim enhancing tumor in the left posterior temporal lobe measures nearly similar to prior exam at 32 x 31 mm compared to prior study measurement of 34 x 31mm. Extensive surrounding vasogenic edema and regional mass-effect is present.There is no evidence of any additional parenchymal or leptomeningeal enhancement to suggest metastatic disease. Calvarium also fail to demonstrate any abnormal enhancement. Ventricular system remains within normal size and it maintains midline.
1.Visualization of metastatic lesions in the right posterior cerebellum with evidence of interval increased size as measured above. A second larger necrotic tumor measures fairly similar to prior exam in the left posterior temporal lobe.2.No additional foci of parenchymal, leptomeningeal, calvarial or orbital metastases.3.No significant mass effect and or deviation of midline.4.Significant acute on chronic pansinusitis with interval worsening since prior exam.