Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49] / Cerebral aneurysm, nonruptured [I67.1], Reason for Study: ^Reason: Brain mets. s/p SRS and WBRT. History: brain mets There is focal enhancing lesion at the right frontal lobe precentral gyrus (series 14, image 137) with surrounding edema indicating possible metastatic lesion. The enhancing lesion appears to be connected with precentral sulcus area. Surrounding T2/FLAIR high signal intensities also appear to be slightly enlarged since prior scan. Reviewing prior scans (10/14/2012 and 4/23/2014), the lesion location is exactly the same as previously noted metastatic lesion. Constellation of above findings suggest the lesion to be a recurrence of the metastatic lesion especially involving cortical surface of precentral gyrus. Differential diagnosis include focal cortical vein thrombosis or subacute ischemic infarction at the pre central gyrus which are less likely.Another enhancing lesion at the left side foramen Luschka area, which is grossly unchanged.Diffuse bihemispheric dural thickening and enhancement are seen, unchanged since prior scan.There is no other new abnormal enhancing lesion.Significant metallic artifacts are seen due to right side surgical clip, unchanged. Left occipital approach catheter is again seen, the catheter tip position is unchanged. The left middle frontal gyrus T2/FLAIR high signal intensity is again seen, unchanged since prior scan and there is no abnormal enhancement.Multifocal FLAIR high signal intensities on bilateral hemispheres unchanged since prior scan. The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. New nodular and curvilinear enhancing lesion at the right precentral gyrus and extends to precentral sulcus implying possible recurrence of metastatic lesion as described above.2. Enhancing lesion at the left side foramen Luschka, diffuse bihemispheric dural enhancement, left occipital approach catheter and multifocal FLAIR high signal intensities are unchanged since prior scan.