 Although more remote outside MRI brain exam are not available, comparison to the most recent outside exam demonstrates no current suspicious enhancing lesions. There is a faint rounded area of enhancement along the medial aspect of the upper left thalamus which could potentially be vascular in etiology or perhaps related to adjacent choroid. A small amount of susceptibility is noted in this location.The ventricles and sulci are prominent, consistent with mild to moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift or mass effect. There are scattered punctate foci and minimally confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, which are nonspecific but may represent mild chronic small vessel ischemic changes. There is a small developmental venous anomaly along the left occipital lobe. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.
1. No definite MR evidence of abnormal intracranial enhancement.2. Small area of ill-defined enhancement projecting along the upper left medial thalamus is favored to possibly be vascular in etiology or represent minimal adjacent choroid. Treated metastasis is felt to be less likely, although there is associated susceptibility.Comparison to more remote outside exams where intracranial metastatic lesions are appreciated would be helpful to assess for follow-up appearance.