 Images are somewhat limited by patient motion.There is redemonstration of an enhancing mildly T2/FLAIR hyperintense and T1 isointense mass in the right posterior frontal lobe measuring 2.0 x 2.2 cm (series 301, image 148). There is minimal localized mass effect and a medial halo of mild diffusion restriction. An additional smaller enhancing lesion in the left precentral gyrus measures 0.7 x 0.7 cm (series 301, image 132). The extent of surrounding T2/FLAIR hyperintensity appears similar to prior exam. This mass also demonstrates diffusion hyperintensity without significant increased signal on ADC. Linear enhancement along the medial right thalamus appears vascular.There is an additional left cerebellar enhancing focus which is not well visualized on the previous exam secondary to patient motion artifact measuring 4 x 4 mm on 1501/56. There is a questioned punctate focus of diffusion restriction in the inferior left cerebellum ventrally, without signal abnormality or enhancement.The ventricles and sulci are mildly prominent compatible with age-related volume loss, aside from the areas of sulcal effacement in the areas of the masses. Nonspecific nonenhancing punctate foci of T2/FLAIR hyperintensity are again seen elsewhere within the white matter. The cisterns remain patent. There is no midline shift. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. A left maxillary retention cyst is noted.
1. Delineation of an additional nodular enhancing focus in the lateral left cerebellum, also likely consistent with metastatic disease. This was not well visualized on prior exam secondary to patient motion.2. Otherwise, motion limited exam, with redemonstration of two lesions in the bilateral posterior frontal lobes with similar extent of surrounding vasogenic edema are most consistent with metastatic disease.3. Scattered nonenhancing nonspecific punctate foci of T2/FLAIR hyperintensity throughout the white matter, which could be compatible with chronic small vessel ischemic changes.4. A questioned focus of diffusion restriction in the ventral left inferior cerebellum not other signal abnormality, which could be artifactual or possibly represent a tiny developing metastasis versus lacunar infarct.