Malignant neoplasm of head, face and neck [C76.0], Reason for Study: ^Reason: eval for vasogenic edema History: known brain mets, nausea, vomiting Brain MRIMotion artifact degraded exam quality.In particular, previously seen enhancing parenchymal nodular lesions at the right temporal lobe mesial aspect, right cerebellar hemisphere and left occipital lobe are not this conspicuous as prior. However, there are subtle enhancing lesions seen on the same locations thus could represent unchanged/stable nodular enhancing lesions.However, on FLAIR/T2 images, the left occipital lobe shows increased signal intensity which may represent post radiation changes of the left occipital lobe lesion more likely. Differential diagnosis could include localized venous congestive encephalopathy based on the findings of distal superior sagittal sinus thrombosis.Soft tissue lesions which is occlusive for the distal superior sagittal sinus to the level of Torcular Herophili appear to be stable. There is no evidence of prominent cortical veins on post contrast scan.Soft tissue mass on the midline occipital scalp is again seen, unchanged since prior scan.Scattered FLAIR/T2 high signal intensity lesions on bilateral periventricular white matter are unchanged and indicate non specific small vessel ischemic disease. The ventricles, sulci and cisterns are unremarkable. The gray-white matter differentiation is normal. The midline structures and cranial-cervical junction are normal. The mastoid air cells are clear. Right sphenoid sinus mucosal thickening is seen.Brain MRV3D MRV brain post-gadolinium with maximum intensity projections of the superficial/deep intracranial venous drainage demonstrate occlusion of the distal Superior Sagittal Sinus (SSS). However, proximal SSS, bilateral transverse sinus and bilateral sigmoid sinuses appear to be normal and patent. Visualization of the deep venous system including bilateral internal cerebral veins, vein of Gallen and straight sinus appear to be patent without evidence of occlusive lesion.
1. Interval development of left occipital lobe FLAIR/T2 high signal intensity. This finding more likely represent post radiation changes. Differential diagnosis though less likely include localized venous congestive encephalopathy.2. Unchanged distal SSS occlusion, midline occipital area scalp mass and although not as conspicuous as prior multiple brain parenchymal enhancing lesions since prior scan.3. No evidence of acute ischemic or hemorrhagic lesion.4. Occlusion of the distal SSS on MRV. However, other cranial venous drainage system appears to be patent with no evidence of occlusive lesion. 5. Due to significant motion artifacts, precise evaluation for new enhancing nodule is not possible.