79-year-old male with questionable brain metastases with improved creatinine. Evaluate for brain metastasis in the presence of contrast enhanced exam. MRI brain:Redemonstrated is a mildly contrast-enhancing, slightly intrinsically T1 bright lesion in the left medial temporal lobe which measures 7 x 6 mm and remains suspicious for a metastasis. The lesion is associated with strong susceptibility effect. Within the limitations of some motion degradation, and absence of the 3-D T1 postcontrast images, no additional intracranial enhancing lesions are seen. There is unchanged nonspecific mild scattered cerebral white matter T2/FLAIR hyperintensity. There is no evidence of acute infarct. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is fluid in the bilateral ethmoid sinuses. MRI C-spine:The C4 vertebral body is expanded and enhancing secondary to tumor involvement. There is prominent extension of tumor into the anterior epidural space which causes moderate spinal canal stenosis at the C4-5 level. Enhancing tumor is also seen within the neural foramina at the C4-5 level bilaterally including surrounding the foramina transversaria as well as extending into the prevertebral soft tissues anterolaterally. Additional paraspinal tumor is suspected only partially visualized on the right at T1 and corresponds with abnormal FDG avid activity on a prior PET/CT from 7/15/2016.The craniovertebral junction appears within normal limits. There is slight reversal of the cervical lordotic curvature There are multilevel degenerative changes of the cervical spine most prominently involving the C5-6 level where there is disc height loss, minimal retrolisthesis of C5 on C6, a small disc osteophyte complex, left foraminal disc protrusion, and facet arthropathy, which contribute to the spinal canal stenosis and moderate left neuroforaminal narrowing at this level. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact.
Redemonstration of a subcentimeter lesion in the left hippocampus which enhances and is suspicious for metastasis, possibly containing blood product.Expansile enhancing C4 vertebral body metastatic lesion extending into the anterior epidural space, contributing to moderate spinal canal stenosis at this level, along with the degenerative changes. Tumor involves the C4-5 neuroforamina, encases the foramina transversaria and extends into the lateral anterior paraspinal soft tissues. An additional paraspinal tumor is suspected but only partially visualized on the right at T1 and corresponds with abnormal FDG avid activity on a prior PET/CT from 7/15/2016.