Clinical question: History of HNC. Signs and symptoms: Multiple brain metastases per last CT. Pre and post enhanced brain MRI:No evidence of restricted diffusion.Examination demonstrate multiple enhancing (some hemorrhagic) metastatic lesions in bilateral cerebral and cerebellar hemispheres.The largest supratentorial metastatic lesion is epicentered in the left caudate nucleus and measures at 21 x 15 mm in transaxial dimensions.The largest right hemispheric metastatic lesion in the posterior parietal lobe measures at approximately 23 x 10 mm in transaxial dimensions. The largest metastatic lesion in the posterior fossa is in the anterior right cerebellum measuring at 29 x 21 mm.Although there is surrounding vasogenic edema of all metastatic lesions and mass effect remains regional and without evidence of midline shift, effacement of basal cisterns, quadrigeminal plate cistern or the foramen magnum. Additionally examination demonstrates a focus of enhancement in the left posterior parietal bone measuring approximately at 12 x 8 mm in transaxial dimensions (axial post enhanced series 10 image 29).Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.
1.Multiple enhancing metastatic lesions (some hemorrhagic) in supra and infratentorial brain parenchyma as detailed/measured above.2.There is no evidence of midline shift or hydrocephalus.3.There is a single nonspecific focus of enhancement in the left parietal bone measuring at 12 x 8 mm and could represent a metastatic focus however possibility of benign lesion cannot be entirely excluded.