58 years, Male, postoperative examination after resection of tumor. There are expected postsurgical changes of left frontal craniotomy for resection of metastatic enhancing left frontal mass. There is intrinsic T1 hyperintensity filling the resection cavity consistent with blood products. There appears to be total tumor resection without definite areas of residual enhancement identified in this location. Again seen is extensive vasogenic edema in the left frontal lobe extending into the superior temporal lobe. There is effacement of the left lateral ventricle which is slightly improved. Rightward midline shift and subfalcine herniation also appear slightly improved. No uncal herniation.Again seen is an 11 x 11 x 9 mm enhancing focus as measured previously involving the left superior and middle temporal gyri consistent with a second lesion. There is mild associated edema.Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Again seen is a punctate focus of diffusion hyperintensity in the left posterior temporal lobe without T2/FLAIR hyperintensity and is of uncertain significance. No hydrocephalus. No abnormal leptomeningeal or dural enhancement appreciated on the postgadolinium sequences which are motion degraded.
1. Expected postsurgical changes related to resection of metastatic left frontal lobe lesion. Again seen is extensive surrounding vasogenic edema with slight improvement in mass effect.2. Unchanged small left temporal lobe lesion consistent with metastasis.