 Despite of IV contrast administration with no gross evidence of contrast extravasation, there is significantly suboptimal contrast enhancement of the brain. Essentially the post contrast images are nondiagnostic due to suboptimal contrast administration/enhancement. This limits evaluation for smaller and newer metastases.There are multiple intra-axial hemorrhagic metastases once again showing high intensity T1 signal, and varying degrees of susceptibility effect.A lesion in the left frontal lobe has significantly increased in size due to interval hemorrhage within the lesion measuring 26 x 23 mm compared with 9 mm previously, with moderate new vasogenic edema.Additionally, there are two lesions in the occipital lobes bilaterally which have bled in the interval, with intraventricular extension in the left occipital horn. These occipital lesions can explain patient's new onset cortical blindness. They measure 40 x 22 mm in the left head 26 x 17 mm on the right. Most of the other masses have decreased in size. Representative measurements are as follows, once again limited due to suboptimal enhancement:1.Stable dural based falcine mass by the vertex measuring 19 x 13 mm without significant associated vasogenic edema2.Stable subcentimeter right parafalcine dural based lesion again seen without significant vasogenic edema3.Stable left superior frontal gyrus lesion best imaged on T2 sequence measuring 8 mm with no significant vasogenic edema4.Smaller left precentral gyrus mass measuring up to 9 mm today compared to 12 mm previously with decreased minimal vasogenic edema5.Smaller left posterior frontal lobe mass measuring 10 mm today compared to 12 mm previously on series 401 image 24 with decreased vasogenic edema6.Smaller left inferior parietal lobule mass measuring 12 mm compared to 23 x 16 mm previously and decreased vasogenic edema7.Smaller left parietal/occipital lobe mass measuring 6 x 18 mm compared to 10 x 20 mm previously (series 401 image 19)8.Smaller right occipital lobe mass on series 40 on image 15 measuring 12 x 6 mm compared to 12 x 14 mm previouslyThere is mild mass effect upon the left occipital horn. There is no hydrocephalus. There is now minimal rightward midline shift due to mass effect on the left lateral ventricle frontal horn from the left frontal lobe hematoma/hemorrhagic lesion. There are scattered foci of high diffusion signal, most of which are also high on the ADC , limiting sensitivity, however there is no definite acute infarction. There is moderate right maxillary sinus mucosal thickening.
1.Multiple hemorrhagic intracranial masses consistent with metastatic disease. At least two masses, in the left frontal lobe and left occipital lobe, have bled in the interval with significant vasogenic edema. There is a right occipital lobe hematoma as well without an underlying lesion seen on the prior MRI which may be due to a new metastasis which underwent interval bleeding, or less likely due to spontaneous parenchymal bleed.2.Essentially all other intracranial metastases have decreased in size and surrounding vasogenic edema status post interval therapy.3.Post contrast images are nondiagnostic due to suboptimal contrast administration/enhancement. This limits evaluation for smaller and newer metastases.