62 years, Male, brain metastases. Also concern for spinal metastases. Brain: Limited sequences per SRS treatment protocol.There are multiple enhancing lesions throughout the brain consistent with metastatic disease and similar to recent prior. There is a 11 x 11 mm lesion in the right frontal lobe, series 30, axial image 126. There is a 2 to 3 mm lesion in the right frontal lobe more posteriorly, axial image 121. There are 2 punctate posterior left frontal lobe lesions, axial images 134 and 120. There is a 6 x 7 mm lesion involving the posterior aspect of the left superior temporal gyrus, axial image 89. There is a 9 x 6 mm lesion involving the right occipital lobe, axial image 65. There is susceptibility compatible with hemorrhage associated with the right frontal and left temporal lesions.There is edema surrounding the relatively larger right frontal, left temporal, and right occipital lesions, which is better assessed on prior T2/FLAIR sequences. There appears to be mild improvement in the edema, but again not well assessed on the available sequences. There is slight increase in size of the left lateral ventricle. No evidence of hydrocephalus. No midline shift or uncal herniation. Multiple foci of enhancement are seen in the calvarium consistent with osseous metastatic disease, relatively more prominent in the right occipital region where there is adjacent mild thickening and enhancement of the adjacent dura, which may be reactive. No definite evidence of dural invasion or leptomeningeal disease. Evidence of small vessel ischemic disease with lacunar infarcts involving the left caudate nucleus, left midbrain, and bilateral cerebellar hemispheres noted.Total spine: CERVICAL SPINE
1. Examination of the brain per SRS treatment planning protocol. There are 6 enhancing lesions in the brain consistent with intracranial metastatic disease as detailed above and similar to outside prior study. There is small amount of hemorrhage associated with the relatively larger right frontal and left temporal lesions.2. Evidence of calvarial metastases which can be correlated with prior bone scan if available. A relatively larger right occipital bone metastasis is associated with mild adjacent dural thickening and enhancement, which may be reactive.3. Chronic small vessel ischemic disease and evidence of multiple supratentorial and infratentorial lacunar infarcts.4. Examination of the spine demonstrate multiple osseous metastatic lesions involving the cervical, thoracic, and lumbar spine as detailed above. No evidence of epidural tumor in the spinal canal. There is mild endplate depressions involving the L2 vertebral body which may represent a pathologic fracture. Vertebral body heights and alignment in the spine are otherwise maintained. There is also a relatively large lesion involving the right sacrum and iliac bone. Please see additional details above.