 There is suggestion of treatment response with decrease in size of multiple previously seen enhancing lesions in the brain. Postcontrast sequences are severely motion degraded. Previously seen right posterior frontal lesion is not definitively appreciated. Left posterior temporal lesion is also not significantly definitively appreciated. There appears to be decreased since size of the enhancing right posterior lateral medulla and right inferior cerebellar lesions. For example right posterior medullary lesion previously measuring 10 x 8 mm measures approximately 7 x 6 mm. Foci of susceptibility are seen compatible with chronic blood products and/or mineralization associated with the prior lesions.No new edema intracranial mass effect, midline shift, or herniation. No hydrocephalus. No extra-axial collections. No evidence of infarct orThere is opacification of the right mastoid air cells.CERVICAL SPINE
1. Please note patient had difficulty tolerating the study and the postcontrast brain sequences are severely motion degraded. There does however appear to be decrease in size and number of the multiple metastatic lesions in the brain. No large new lesion is appreciated. Repeat post gadolinium brain MRI sequences can be considered as clinically indicated. 2. Evaluation of the spine demonstrates no definite evidence of metastatic disease within the limitations of the motion degraded postcontrast sequences. Compared to 8/12/2015, 8 mm enhancing lesion involving the L4 vertebral body remains unchanged. This lesion is nonspecific and may be benign.3. Given the extent of motion degradation on the brain and spine sequences, if there is high suspicion of progression of metastatic disease, repeat study limited to post gadolinium sequences of the brain and complete spine can be considered.