Reason: history of metastatic colon cancer with new brain metastasis s/p resection; please evaluate for radiosurgery treatment planning History: brain mass The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status-post left-sided posterior fossa craniotomy and left cerebellar surgery. There are multiple enhancing lesions present in the left cerebellar hemisphere and vermis. One ring enhancing lesion in the inferior aspect of the right side of the vermis measures 5 mm in diameter. One in the medial aspect of the left cerebellar hemisphere along the inferior semilunar lobule measures 7 x 6 mm. One along the lateral aspect of the inferior left semilunar lobule measures 11 x 12 mm. There is contrast enhancement present along the edge surgical planes in the left cerebral hemisphere with a nodular component measuring 5 x 7 mm axial dimensions.There is a 6-mm enhancing lesion located in the left thalamus which was also present on the prior exam, however, because it was previously evaluated using T2 imaging direct comparison is not possible.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Status post left cerebellar surgery with the residual enhancement at the surgical site.2.There multiple small ring enhancing lesions present in the cerebellar vermis, the medial and lateral aspect of the left cerebellar hemisphere as well as in the left thalamus. Given the patient's clinical history, metastatic disease is a strong consideration. There are no prior contrast enhanced MRI of the brain studies available