51 years, Male, known intracranial lesions. Examination is obtained for surgical planning and limited to 3-D T2 and postgadolinium T1-weighted images, which are motion degraded. Again seen are numerous peripherally enhancing lesions throughout the bilateral cerebral hemispheres as well in the posterior fossa including the left anterior cerebellar hemisphere. Additional foci of enhancement in the posterior fossa along the posterior wall of the fourth ventricle and the left pons may be artifactual or related to small additional lesions which are not adequately evaluated on the motion degraded study.These lesions have increased in size since 10/13/2016. For example a left occipital lesion previously measuring approximately 20 mm in the AP dimension, now measures 25 mm. There is also increased mass effect with these lesions particularly within left frontal lesion which is associated with increased effacement of the left lateral ventricle and downward mass effect on the anterior callosal body. There is no significant midline shift or herniation. No hydrocephalus.Postsurgical changes of right frontal craniotomy related to prior biopsy. Enhancing lytic lesion involving the left parietal calvarium is again seen seen. Additional smaller left sphenoid/temporal bone lesion better seen on prior CT. Major flow-voids are preserved. There is distention of the optic sheaths likely reflecting elevated intracranial pressure. There is moderate opacification of the bilateral mastoid air cells.
1. Motion degraded exam limited to sequences for operative planning. Since prior MRI from 10/13/2016, there has been enlargement of numerous peripherally enhancing intracranial lesions throughout the cerebral hemispheres with mild involvement of the posterior fossa. Lytic calvarial lesions involving the left parietal bone and at the junction of the left greater wing of the sphenoid and squamous temporal bone also again seen, the latter which is better seen on recent CT. There is increase in local mass effect. Differentials again include metastatic disease and infection.2. Distention of the optic sheaths likely reflecting elevated intracranial pressure.