Female, 51 years old, history of lung cancer with brain metastases, presenting with dizziness, assess for progression. Brain MRI:Extensive metallic artifact is seen due to the placement of aneurysm clips along the right sylvian fissure and suprasellar region, and due to shunt apparatus in the posterior fossa. Diffusion-weighted images are particularly degraded, but within this limitation, no definite restricted diffusion is seen.Small bilateral subdural collections are again seen, predominantly along the frontal lobes, stable on the right and improved on the left. Diffuse dural thickening is also noted along both frontal lobes but particularly on the left where it is thicker than that seen on the prior exam.New small patches of parenchymal T2 hyperintensity are seen within the left and right middle frontal gyri of uncertain significance. Multiple scattered small foci of white matter T2 hyperintensity are also seen in the periventricular and subcortical white matter. Some of these may be new or perhaps just better visualized due to imaging at 3T. No evidence of any significant parenchymal edema or mass effect is observed.The left posterior fossa catheter system remains in stable position. Amorphous enhancement and T2 hyperintensity along the distal end of the catheter tip, at the level of the left foramen of Luschka, have not significantly changed from the prior examination. No additional or new pathologic enhancement is seen within the posterior fossa or in the cerebral hemispheres.The ventricular system is normal in size. A subcentimeter pineal region cystic lesion is again visualized. No evidence of new intracranial hemorrhage is detected. A few scattered punctate foci of susceptibility in the cerebral hemispheres are better visualized than on prior, likely due to imaging at 3T.Sequelae of right pterional craniotomy and multiple bilateral burr holes are again seen.Brain MRA:The distal right ICA and most of the proximal MCA is not visualized due to metallic artifact. The regions of the right PCOM and the ACOM arteries are also obscured. There is a relative paucity of right MCA distribution vessels. Elsewhere, no significant vascular stenosis is suspected. A 2.0 x 2.5 mm outpouching is evident from the left MCA bifurcation directed anteriorly and inferiorly. This appears similar to the prior CTA examination. There is also a 1 mm medially directed outpouching off of the left cavernous ICA which appears similar to the prior CTA. No additional aneurysms are suspected.Neck MRA:MRA image quality is slightly suboptimal but still diagnostic. No evidence of any significant vascular stenosis or occlusion is seen within the carotid or vertebral vessels of the neck.
1.No definite evidence of acute ischemia or any other definite acute intracranial abnormality allowing for substantial artifact related to prior surgical interventions.2.Small bilateral subdural collections are again seen, primarily along the frontal lobes. These are stable on the right and improved on the left relative to the prior MRI examination. Significant dural thickening is also seen along both frontal lobes but particularly on the left which is likely reactive to the long-standing subdural collections.3.New patches of T2 hyperintensity are seen within the left and right middle frontal gyri. These are of uncertain significance but could reflect the sequelae of prior parenchymal injury related to the previously seen large subdural collections.4.Numerous scattered small white matter lesions are also seen which are nonspecific but may reflect chronic microvascular ischemic disease.5.A left posterior fossa catheter system is in stable position. Amorphous signal abnormality and enhancement along the distal aspect of the catheter shows no significant interval change from the prior examination.6.No new parenchymal enhancing lesions are seen.7.On MRA imaging of the brain, there is a relative paucity of right MCA vessels which may be related to prior treatment of numerous aneurysms. Otherwise, no significant vascular stenosis is suspected.8.A 2.0 x 2.5 mm aneurysm arising at the left MCA bifurcation is unchanged relative to the prior CTA. Similarly, a 1 mm outpouching from the left cavernous ICA is also unchanged.9.Unremarkable MRA evaluation of the neck.