Metastatic RCC with history of brain metastases. History of MS. There is redemonstration of an irregularly marginated lesion in the right parietal centrum semiovale with an ill-defined, granular pattern of enhancement. There is associated susceptibility artifact compatible with hemosiderin staining. This lesion is not significantly changed compared to the most immediate prior study, however, does appear to have slightly fuller enhancement along the inferior margin when compared to older studies. The surrounding T2 hyperintensity is unchanged. There is redemonstration of an ill-defined lesion within the left paramedian cerebellum with a similar pattern of enhancement and susceptibility artifact to the right parietal lesion. The lesion has continued to increase in size, most predominately in the transverse dimension medially, now measuring approximately 16 x 10 mm (image 108, series 12), previously 11 x 10 mm. The surrounding T2 hyperintensity has increased as well. There is confluent white matter high T2 signal within bilateral cerebral hemispheres, right greater than left. Foci of high T2 signal within the right cerebellar hemisphere appear similar to the prior study. The ventricles are unchanged in size and shape. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable.
1. A hemosiderin stained, ill-defined enhancing lesion in the right parietal centrum semiovale is not significantly changed from the prior exam, but does demonstrate slightly fuller enhancement when compared to older studies. 2. Increased size of a similar-appearing smaller lesion within the the left paramedian cerebellum when compared to the most recent and older studies. 