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Pre-Surgery Planning MRI Report 7/16/2023

The surgery was performed on 7/17/2023.

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MR BRAINNAV WITH AND WITHOUT CONTRAST DTI:  7/16/2023 10:00 AM

INDICATION (as provided by referring clinician): Presurgical Planning

ADDITIONAL HISTORY: metastatic melanoma to the lung and brain with prior recurrence, s/p multiple resections and radiation for brain metastases (last completed stereotactic radiation in the right temporal horn on 10/12/2022). Currently on Nivolumab maintenance with an Ipilimumab "booster" every 6 months. The first day of q 6 month ipiwasadded to Cycle 5 nivo on 5/3/23.

COMPARISON: MRI brain 7/1/2023.

TECHNIQUE: Multiple sequences through the brain were acquired at 3.0 tesla.

MEDICATIONS:

Dotarem - 16.4 mL - Intravenous

FINDINGS:

Postsurgical changes following prior right temporal and left parieto-occipital craniotomy. Compared to MRI of 7/1/2023, overall increased size of multiple areas of nodular enhancement throughout the bilateral supratentorial brain. For example, subependymal nodule along the posterior left intraventricular septum measures 1.2 x 0.6 cm (11:88) compared to 1.0 x 0.4 cm previously, subependymal enhancement along the left temporal horn measures 1.8 x 1.1 cm (11:49) compared to 1.5 x 0.9 cm previously, and newly apparent subependymal enhancement along the left frontal horn (11:79). Enhancement along the margins of the left occipital resection cavity and right temporal horn appear similar to minimally increased. Areas of enhancement demonstrate associated reduced diffusion, increased perfusion and surrounding T2/FLAIR hyperintensity, particularly along the left occipital resection cavity. Similar extent of associated mass effect without midline shift or herniation.

Additional nonenhancing foci of T2/FLAIR hyperintensity in the bilateral periventricular and deep white matter are nonspecific but unchanged. No acute infarct or hemorrhage. 

The ventricles remain similar in size and configuration. No hydrocephalus. No extra-axial collection.

Unchanged small bilateral mastoid effusions.

IMPRESSION: 

MRI obtained for presurgical planning.

1.  Compared to 7/1/2023, evidence of progression with increased nodular enhancement along the left parieto-occipital resection cavity and bilateral subependymal surfaces. No midline shift, herniation or hydrocephalus.

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