63 years, Male, right upper extremity motor and sensory deficits, lower extremity weakness. Evaluate for progression of metastatic disease.. Again seen is evidence of diffuse intracranial metastatic disease with numerous small lesions scattered throughout the brain. Many of these lesions appear mildly larger. For example a right superior frontal gyrus lesion measures 8 x 9 mm previously 6 x 6 mm. A lesion involving the lateral aspect of the left precentral gyrus measures 4 mm previously 3 mm. No new lesion is definitively appreciated. There is susceptibility effect associated with several of the lesions lesions compatible with blood products and more conspicuous in the interval although these changes may be in part related to technique differences with the current study done on 3 Tesla and prior on 1.5 Tesla. There are foci of microhemorrhage involving the bilateral cerebellar hemispheres with minimal vasogenic edema which are new since prior and correspond to sites of small metastatic lesions.There is no evidence of acute infarct. No significant intracranial mass effect associated with the subcentimeter lesions. There is patchy T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter as well as in the pons similar to prior likely reflective of chronic small vessel ischemic disease. There are chronic lacunar infarcts involving the left basal ganglia including the caudate head and putamen. Ventricles are not significantly changed in size. Enhancing lesion involving the right lateral occipital bone with soft tissue extension is again seen measuring approximately 31 x 22 mm similar to prior. Enhancing focus involving the left mandibular condyle measuring 14 x 12 mm is stable to minimally more prominent. Additional osseous metastatic foci including the clivus and left occipital condyle are also stable to minimally more conspicuous in the interval. Small scattered enhancing foci in the scalp are again noted such as in the left parietal scalp and involving the left temporalis muscle and may also represent represent metastases. There is diffuse opacification of the right mastoid air cells and to a minimal degree on the left, grossly similar to prior. Mild right maxillary sinus mucosal thickening also similar to prior.
1. Compared to MRI dated 9/21/2016, there is mild progression of diffuse intracranial metastatic disease with several lesions appearing larger or more conspicuous. Also noted is mild interval increase in small amount of blood products associated with the metastases. No significant edema or mass effect associated with the numerous subcentimeter lesions.2. Osseous and scalp metastases are again seen and stable to minimally more prominent.3. Chronic left basal ganglia infarcts.