Clinical question: History of brain metastases. Please compare with prior exam. Signs and symptoms: Not. Pre and post enhanced brain MRI:No acute intracranial process. A previously known enhancing metastatic lesion in the high convexity right frontal lobe measures at 4.8 x 7.4 mm compared to prior study remeasurement of 4.1 x 6.4 mm.A right frontal cortical enhancing metastatic lesion measuring 4 x 3.4 mm in transaxial dimensions compared to prior study which was barely identified.A left occipital metastatic lesion measuring at 3.8 mm in transaxial dimensions compared to prior study measurement of 1.8 mm is noted.There is no significant surrounding edema with tumors and none with evidence of mass effect.Diffusion weighted images are negative and findings of mild chronic nonhemorrhagic small vessel ischemic strokes are present only in the subcortical and periventricular white matter of cerebral hemispheres without change since prior exam.Ventricular systems remain within normal size and with maintained midline. There is no detectable calvarial metastatic lesions.Unremarkable images through the orbits including axial fat sat postcontrast enhanced series.Paranasal sinuses and bilateral mastoid air cells and middle ear cavities remain well pneumatized.
1.Multiple small metastatic lesions all measure minimally larger since prior and without necrosis as measured above.2.Negative diffusion weighted images and findings of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.