Radiologist said unchanged 9mm metastases (#9) on 10/12, which is 19 days after the previous report. My radiation oncologist said it looked a very tiny bit smaller to her. My first new immunotherapy treatment was 10/4, so 8 days previously. She said my immune system may still be primed after a little over 3 years of Ipi/Nivo tx ending May 2021, and that it's possible it had a small effect. It does seem true that the lesion was in fact slow growing, as indicated by the growth from 3mm to 9mm from 6/27 to 9/23.
She said the new lesion was adjacent to and possibly touching where a previously treated region was, which being on the right side would be the one (#7) treated on 12/19/18.
*********************************************
Exam Date: 10/12/2022
Exam(s): MR BRAIN STEREOTACTIC WITH AND WITHOUT CONTRAST
Exam Status: Final
MR BRAIN STEREOTACTIC WITH AND WITHOUT CONTRAST: 10/12/2022 9:58 AM
INDICATION (as provided by referring clinician): Gamma Knife radiosurgery for new brain metastasis from melanoma
ADDITIONAL HISTORY: metastatic NRAS mutant melanoma diagnosed in 2010 with lung and brain metastases s/p multiple resections andmultiple priorcourses of radiation treatment for brain metastases(most recently GK SRSto a single left lateral ventricle lesion, 17 Gy,on 3/19/19, Dr. Fogh), off immunotherapy since 5/2021, now with progressive intracranial disease in the right temporal horn.
COMPARISON: MRI brain 9/23/2022
TECHNIQUE: Multiple sequences through the brain were acquired at 3.0 tesla.
MEDICATIONS:
Dotarem - 32 mL - Intravenous
FINDINGS:
MRI examination optimized primarily for therapeutic planning and guidance. Patient is imaged in a stereotactic frame.
Lesions identified which are potentially targets for radiation therapy are described on axial reformats of 3D post-contrast T1 images (series 3):
* 9 mm lesion in the temporal horn of the right lateral ventricle, image 71
No new intracranial metastases.
No evidence of leptomeningeal disease, new significant intra-lesional hemorrhage, hydrocephalus, or midline shift.
Again seen are postoperative changes of prior right temporal and left parieto-occipital craniotomies with underlying resection cavities. Similar appearance of nodular enhancement along the medial and posterior aspect of the left occipital resection cavity, and within the central aspect of the right temporal resection cavity. Similar FLAIR signal around the resection cavities.
Unchanged FLAIR hyperintensity with encephalomalacia and gliosis involving the bilateral inferior frontal lobes, likely sequela of prior injury.
IMPRESSION:
Compared to 9/23/2022, stable size of 9 mm lesion in the temporal horn of the right lateral ventricle. No new intracranial metastases.
Comments
Post a Comment