Metastatic brain lesions. Follow-up evaluation. Again seen are postsurgical changes of left frontal and left temporal craniotomy for tumor resection. There is encephalomalacia involving the left frontal lobe with T2/FLAIR hyperintensity compatible with gliosis which is unchanged. There is extra-axial dural based thickening in the surgical bed measuring which remains unchanged and likely representing granulation tissue. Again seen is an area of increased T2/FLAIR signal in the cortex and subcortical white matter of the left anterior temporal lobe similar to prior. There is a punctate focus of enhancement along the surface of the left temporal lobe which measures up to 6 mm and not significantly changed since at least 7/29/2015 allowing for slight differences in technique. This lesion is not seen on several earlier studies although corresponds to a site of an enhancing lesion on 3/2/2011.No new mass or mass-effect. No abnormal parenchymal or abnormal meningeal enhancement elsewhere in the brain is seen. No hydrocephalus. No evidence of acute ischemia or hemorrhage. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear.
1.Stable postoperative changes related to resection of a metastatic lesion with stable areas of encephalomalacia/gliosis in the anterior left frontal lobe. Adjacent extra-axial enhancing area remains unchanged and likely represents scarring.2.No new or enlarging lesions to suggest progression of metastatic disease.3.Again seen is T2/FLAIR hyperintensity in the anterior left temporal lobe and adjacent nodular focus of enhancement measuring up to 6 mm, which is not significantly changed since at least 7/29/2015 and corresponds to a site of prior treated/resected lesion in 2011. Recommend continued attention on follow-up.