 There is a stable 6 mm ring-enhancing lesion in the superior gyrus of the right frontal lobe. Interval development of multiple satellite lesions with nodular and curvilinear somewhat cortically based enhancement are now present in this region. There is increased surrounding hyperintense T2/FLAIR signal compatible with worsening edema without significant mass effect, which would not be unexpected in posttreatment imaging. However, a 3 mm enhancing focus is more conspicuous in the region of previously demonstrated focal T2/FLAIR hyperintensity. There are also now a few satellite punctate foci of enhancement in this region as well. As suggested previously, the nonenhancing focus of T1 hypointensity/FLAIR hyperintensity in the left frontal lobe likely represents small vessel ischemic disease. Stable focus of susceptibility in the right frontal lobe compatible with microhemorrhage.The cortical sulci are in proportion to the cerebral ventricles. No intra-axial or extra-axial fluid collections are visualized. There is no midline shift or mass effect. The basal cisterns are visualized.
1.Stable ring-enhancing 6 mm lesion in the right superior frontal gyrus with new foci of surrounding nodular and curvilinear somewhat cortically based enhancement, with increased extent of FLAIR abnormality as well; differential includes true disease progression versus posttreatment effects. Continued follow-up is suggested.2.Interval increased enhancement of a 3 mm lesion in the right temporal lobe middle gyrus which was not reportedly treated, with a few new surrounding punctate foci of enhancement in the region of previously demonstrated FLAIR signal abnormality is suspicious for progressive metastatic disease.