Female, 71 years old, with altered mental status. Assess for worsening brain metastases versus edema. Diffuse ependymal nodularity and enhancement is redemonstrated involving the entire ventricular system. The enhancement pattern of some of the nodules has changed in that they appear more rim-enhancing rather than solidly enhancing. Some of the nodules have increased in size, for example along the left ventricular atrium and within the third ventricle. A nodule along the floor of the right frontal horn appears to be slightly smaller. Leptomeningeal enhancement along the ventral surface of the brainstem is also perhaps slightly increased in prominence. T2 hyperintensity surrounding the ventricular system shows variable interval changes. For example, extent of the signal abnormality has slightly increased along the left frontal lobe, but has improved along the right frontal horn. The ventricles remain generally prominent, but the caliber of the lateral ventricles has decreased. The third ventricle is unchanged in size and the fourth ventricle appears slightly more prominent. No evidence of acute intracranial hemorrhage is seen.
Findings are demonstrated compatible with diffuse ependymal and leptomeningeal metastatic disease. On comparison with the prior examination, the overall impression is of slightly worsening disease though in some areas tumor nodularity has decreased in size.