Female, 83 years old, with history of lung cancer, with abnormal findings on a prior head CT concerning for intracranial metastases. Post contrast images are degraded by motion artifact. Within this limitation, an irregularly marginated rim-enhancing mass is demonstrated at the junction of the right occipital and temporal lobes which measures up to 32 x 24 x 20 mm. Internally, this lesion is diffusion restricting with a few punctate foci of susceptibility suggesting microhemorrhage. This lesion induces moderate vasogenic edema which tracks through the temporal, occipital and parietal lobes. A 9 mm satellite nodule is also suspected more posteriorly within the right occipital lobe.Postcontrast images are unreliable for assessment of the posterior fossa. However, there are scattered areas of T2 FLAIR hyperintensity throughout both cerebellar hemispheres which are nonspecific.On diffusion weighted images, multiple scattered small hyperintense lesions are seen along the watershed zones of both cerebral hemispheres. At least one and probably several small diffusion restricting lesions are also evident in the cerebellar hemispheres. No detectable mass effect or enhancement is seen in association with these diffusion restricting lesions.Findings related to extensive prior microvascular ischemia are seen including patchy periventricular T2 hyperintensity. Chronic lacunar infarcts are also evident within the right thalamus and possibly the right basal ganglia. Numerous chronic small infarcts are seen within the cerebellar hemispheres. Susceptibility effect compatible with chronic microhemorrhage is seen in the cerebellar vermis.No abnormal extra-axial fluid collections are detected. The ventricular system is unremarkable with the exception of effacement of the right ventricular atrium due to mass effect.A mass is evident within the left parieto-occipital scalp measuring 50 x 50 x 20 mm. This lesion is composed of a substantial extracranial component in addition to a component which invades the underlying bone marrow extending all the way to the inner table. Contact with the underlying dura cannot be excluded, though there is no evidence of invasion into the adjacent brain parenchyma. Additional smaller osseous masses are seen including one within the posterior right frontal bone and one within the right occipital bone.
1.An irregularly marginated rim-enhancing masslike lesion is seen at the junction of the right occipital and temporal lobes which, given the history, is highly suspicious for an intracranial metastatic lesion. A subcentimeter satellite lesion is also noted somewhat more posteriorly.2.Multiple osseous metastatic lesions are also seen with a dominant lesion noted at the left parietal region. This tumor invades the underlying bone extending at least to the inner table if not the dura, but there is no evidence of invasion of the underlying brain.3.Due to the fact that postcontrast images were severely degraded by motion artifact, the possibility of additional smaller parenchymal metastatic lesions cannot be excluded. Areas of T2 signal abnormality within the cerebellum are nonspecific and could potentially just represent vascular lesions.4.Multiple scattered foci of restricted diffusion are seen in a fairly symmetric distribution along the watershed zones of the cerebral hemispheres. These are favored to represent small perfusional infarcts. One or perhaps several small acute infarcts are also suspected within the cerebellum in the context of fairly extensive chronic ischemic disease.