Planning for radiosurgery, brain mass, anticipating radiosurgery. Limited examination performed for radiosurgery planning again demonstrates a 9 x 9 mm enhancing lesion in the posterior right frontal lobe involving the medial aspect of the precentral gyrus with a moderate amount amount of surrounding vasogenic edema. There is mild local mass effect without midline shift or herniation. There is a faint 2 mm focus of enhancement involving the left anterior frontal lobe (series 2103 image 84), better seen on prior examination. No additional abnormal parenchymal or meningeal enhancement is appreciated. There is mild prominence of the cortical sulci consistent with global volume loss. The ventricles are within normal limits in size and configuration. Patchy areas of T2 hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Major flow-voids are preserved. Small foci of gradient susceptibility along the posterior horns of the lateral ventricles, right greater than left, are nonspecific however appears similar to prior examination and may be related to hemosiderin deposition or mineralization. There is a 1.8 x 1.0 cm area of abnormal signal involving the medial anterior left maxillary sinus consistent with bone on prior CT, and appearing to correlate with an area of increased radiotracer activity seen on prior bone scan (series 5, image 23). There is an approximately 2.1 x 1.8 cm expansile lesion involving the left sphenoid wing (series 5, image 46). There is again a small enhancing lesion involving the left frontal calvarium suspicious for osseous metastatic disease, similar to prior examination.
1. Stable larger posterior right frontal and punctate left anterior frontal lobe enhancing lesions compatible with metastatic disease. 2. Redemonstration of left frontal calvarial enhancing lesion, suspicious for osseous metastasis.3. Area of intermediate signal along the medial anterior left maxillary sinus correlating to bone on prior CT and an area of increased radiotracer activity seen on prior bone scan. This may relate to fibrous dysplasia, however given patient's history, continued follow-up is recommended.4. An expansile lesion involving the left sphenoid wing is also nonspecific however may also be related to fibrous dysplasia. 5. Mild chronic small vessel ischemic disease.