Secondary malignant neoplasm of brain [C79.31], Reason for Study: ^Reason: history of brain metastases s/p whole brain radiation History: none Brain MRIMotion artifact degraded image quality.There is no evidence of acute ischemic or hemorrhagic lesion.Multifocal bihemispheric scattered variable sized enhancing metastatic lesions including right frontal bone lesion do not show any significant interval change since prior scan.Underlying brain shows patch scattered FLAIR high signal intensity lesions on bilateral periventricular white matter indicating nonspecific small vessel ischemic disease, unchanged since prior scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. The paranasal sinuses and mastoid air cells are clear.Thoracic MRIThere is a laminectomy with external fixation T4 to T6.Multi-level vertebral body enhancing lesions are seen at T2, T4, T5, T6, T8 and L3 indicating metastatic lesions.Due to retropulsion of the T5 vertebral lesion, the spinal canal at this level shows severe stenosis. The spinal cord at this level cannot be precisely evaluated due to metallic artifacts.The T8 compression fracture appears to be progressed from about 30% to 50%. The right posterior aspect of the tumor mass abuts the thecal sac which is slightly progressed comparing to prior scan, but no significant retropulsion is seen and spinal cord signal intensity is normal. At this level, right side neural foramen shows minimal narrowing.In addition, there is about 41mm x 24mm sized right T6 level pleura based enhancing soft tissue mass likely represent either pleural metastatic lesion or right T6 rib lesion appears to be enlarged than prior scan. There is large amount of left pleural effusion.
1. No interval change of multifocal various sized brain metastatic lesions since prior scan.2. No evidence of acute ischemic or hemorrhagic lesion.3. Interval progression of metastatic vertebral lesions since prior scan. For example, T8 vertebral compression fracture has progressed, the right T6 extrapulmonary lesion has grown and the new development of pleural effusion.