 Enhancing, intrinsically T1 hyperintense treated metastatic lesion in the right superior frontal gyrus is essentially stable to minimally increased in size, measuring 1.1 x 0.9 cm (series 1201, image 117), previously measuring 1.0 x 0.8 cm. Area of enhancement in the center of the lesion has become more bilobed in appearance. There is a nonenhancing cystic degenerative appearing component located just laterally. Marginal surrounding FLAIR hyperintensity is again noted. This lesion is also associated with susceptibility artifact.There is subtle interval increase in size of the punctate enhancing metastasis in the right superior occipital lobe, now measuring up to 6 mm, previously 4 mm. The left posterior temporal occipital metastatic lesion appears stable to minimally increased in size measuring 5 x 4 mm, previously measuring 4 x 4 mm. This lesion also is more confluent in enhancement and is also associated with susceptibility artifact. 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. There are stable scattered nonspecific punctate foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which may represent mild chronic small vessel ischemic changes in a patient of this age. A tiny anterior right parietal developmental venous anomaly is again seen. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. Incidental nonenhancing cystic structure associated with the pineal gland is again noted. The remainder of the midline structures and craniocervical junction are within normal limits. Stable heterogeneous appearance with overall diffusely decreased T1 signal intensity of the calvarium, with more normal-appearing marrow in the clivus. Postoperative changes are seen from previous bilateral antrostomies. Patchy mild opacification of the ethmoid air cells and possible small air-fluid levels in the bilateral maxillary sinuses.
1. Stable to subtle interval increase in size of bilateral supratentorial metastatic lesions. There is a definite gradual increase in size of these lesions when compared to the more remote exam on 10/6/2015.2. Stable appearance of nonspecific, nonenhancing punctate foci of T2/FLAIR hyperintensity within the white matter.3. Possible small air-fluid levels in the bilateral maxillary sinuses. Correlate clinically for acute sinusitis.