Clinical question: Evaluate brain metastases. Signs and symptoms: Evaluate brain metastases. Pre and post enhanced brain MRI:Examination demonstrates further interval improvement of metastatic lesions since prior study. Several of the previously noted tiny metastatic lesions in supratentorial space are no longer identified. The remaining 2 lesions measure smaller than prior exam. A remaining metastatic lesion along the medial aspect of left posterior temporal lobe measures at 1.6 mm in transaxial dimensions compared to prior study the measurement of 3.1. A tiny cortical-based left parieto-occipital fissure metastatic lesion measures at 2.2 mm compared to prior study the measurement of 3.4 mm. There is also interval decreased size of 2 tiny metastatic lesions in the posterior fossa on the right side. The remaining larger lesion measures approximately 6 mm in size compared to prior study measurement of 9 mm and the smaller in the measures approximately 2.5 mm in size compared to prior study remeasurement of 5.6 mm.None of the remaining lesions demonstrate any surrounding vasogenic edema or enhancement.Stable CSF signal intensity cyst in the pineal region.Diffuse and patchy foci of FLAIR hyperintensity in bilateral hemispheric white matter and pons are more conspicuous on current exam and suspected of post treatment/radiation change.
1.Interval further decrease in size of remaining metastatic lesions and some with interval complete resolution as detailed/measured above.2.More conspicuous patchy and confluent foci of FLAIR hyperintensity of bilateral hemispheric white matter and pons likely representing post treatment/radiation change.3.No intracranial edema, mass effect or ventriculomegaly.