Reason: follow up brain metastases History: none. The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a 5-mm lesion located in the left cerebellar hemisphere which previously had a ringlike appearance and measured 8 x 10 mm axial dimensions. A small lesion in located in the right the superior semi-lunar lobule is not readily identified on the current exam. A left inferior parietal lobule lesion identified on the prior exam as the ringlike lesion measuring 6 mm malice simply a punctate lesion. A right caudate nucleus lesion previously identified is not readily identified on the current exam. A left centrum semiovale lesion is also not readily identified on the current exam. A right frontal lobe lesion along the lateral aspect of the superior frontal gyrus is also not readily identified on the current exam and previously measured 4 mm and was ringlike.There is redemonstration of a encephalomalacia along the right orbital gyrus.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.On susceptibility imaging there are punctate foci of signal loss present involving the subcortical junction which were also present on the prior exam. These are smaller and correspond to metastatic foci.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate opacification of the left mastoid air cells. The visualized portions of the orbits are intact.
1.Since the previous exam there has been regression in size and the visibility of the brain parenchymal lesions compatible with metastatic disease.2.Encephalomalacia along the right orbital gyrus.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 4.Since the prior exam patient has developed some opacification of left mastoid air cells which is a nonspecific and could to represent either fluid retention or inflammatory change. Please correlate with patient's clinical signs and symptoms.