Clinical question: Brain metastases, extent? Signs and symptoms: None. Pre and post enhanced brain MRI:Examination demonstrates a well-demarcated inhomogeneously enhancing intra-axial left posterior paramedian parietal high convexity metastatic lesion. It measures at 32 x 23 x 30 mm in size. There is surrounding vasogenic edema with resultant regional mass effect which includes a mass effect on the left lateral ventricle.Additional focus of enhancement in the left basal ganglia measuring at 5 mm in transaxial dimensions without appreciable surrounding edema or mass effect. There is no convincing evidence of any additional parenchymal or leptomeningeal metastatic lesions.Calvarium also demonstrate normal signal intensity without evidence of abnormal enhancement/ metastases.Unremarkable images through the orbits.Examination in addition demonstrate multiple small foci of FLAIR hyperintensity in the subcortical and periventricular white matter of cerebral hemispheres suggestive of mild chronic small vessel ischemic strokes.The signal void of major intracranial arterial branches are identified.
1.Left paramedian posterior parietal paramedian mildly hemorrhagic metastatic lesion measuring 32 x 23 x 30 mm with surrounding vasogenic edema and regional mass effect.2.5 mm enhancing metastatic lesion in the left basal ganglia as detailed.3.Negative diffusion weighted images and findings suggestive of mild chronic small vessel ischemic strokes.4.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.