Reason: history of breast cancer and multiple brain mets; received prior whole brain radiation, now s/p radiosurgery; please evaluate for response History: brain metastases. Prior surgery (2/2011), WBRT(3/2011) SRS (R cerebellum, R parietal on 6/4/15)(cerebellar vermis on6/8/15) Postoperative findings of left parieto-occipital craniotomy. Confluent T2 hyperintensity in the treatment bed appears similar to the prior exam. Diffuse volume loss as well as ex vacuo dilatation of the left occipital horn is unchanged.Enhancing nodule in the right parietal lobe is unchanged measuring 5 mm (1 101/56), previously 6 mm. Enhancing focus along the inferior surface of the right cerebellum is unchanged measuring 7 x 5 mm (1101/12). Two adjacent punctate enhancing foci in the right cerebellum are unchanged (1102/147). A 6 mm lesion in the cerebellar vermis is unchanged (1101/29). An enhancing focus in the right sylvian fissure seen on the coronal views likely represents a vessel. No new enhancing lesions are evident. There may be slightly increased T2 signal adjacent to the vermian lesion, however the remaining T2 signal is unchanged including periventricular, right parietal and left parietal hyperintensities.There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and paranasal sinuses are unremarkable. Enhancement within the right internal auditory canal is unchanged. A DVA with adjacent foci of susceptibility within the pons is unchanged.
Multiple metastatic lesions are overall stable without evidence of new metastases.