 There has been interval appearance of at least three small enhancing nodular lesions along the right anterior temporal lobe and a single small enhancing lesion along the left anterior temporal lobe with surrounding FLAIR signal abnormality indicating vasogenic edema. The largest lesion in the tip of the right anterior lobe measures 8 x 9 mm (series 5, image 46). These findings are suspicious for metastatic lesions.There is unchanged underlying scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. A left frontal developmental venous anomaly is again incidentally noted. There is no diffusion abnormality. No extra-axial fluid collection is identified. The ventricles and sulci are prominent, consistent with mild age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Again seen is a left maxillary sinus mucosal retention cyst.
Interval appearance of multiple small enhancing masslike lesions in the right greater than left anterior temporal lobes with surrounding FLAIR signal abnormality indicating vasogenic edema. Differential considerations include radiation necrosis and metastases.