Female, 62 years old, history of breast cancer with brain metastases treated with whole brain radiation therapy and subsequent leptomeningeal carcinomatosis. Receiving intrathecal chemotherapy. Brain:Since the prior examination, a right sided ventricular catheter has been placed which traverses the right frontal lobe and terminates in the right frontal horn. Also new is a right sided subdural collection measuring up to 6 mm in thickness extending along the frontal and parietal lobes. This collection follows CSF signal on all sequences and is free of susceptibility artifact.Significant diffuse bilateral T2 hyperintensity has progressed within the white matter of the frontal and parietal lobes and to a lesser degree the temporal lobes. There was some white matter signal abnormality evident on the prior examination, but it is now more extensive and confluent. Only mild scattered white matter hyperintensities were seen on the prior examination from May 2014.Supratentorially, scattered areas of pathologic enhancement are seen, for example within the left hypothalamus and along the tectum. Relative to the prior exam, these areas are less well defined. A 3-mm focus of enhancement within the posterior right temporal lobe is unchanged. Enhancement of the cisternal segment of the right fifth cranial nerve, and the canalicular segments of the seventh/eighth nerve complexes, as well as of the temporal bone segments of the seventh cranial nerves, appear slightly more prominent though this could be technical. Infratentorially, numerous patches of enhancement throughout the cerebellar hemispheres and vermis are demonstrated. These lesions are slightly less well defined and as a result some measure smaller than before. No definite new lesions are seen. The degree of parenchymal T2 hyperintensity in the cerebellum has probably improved. No definite evidence of parenchymal hemorrhage is seen. No significant mass effect is detected. The ventricles have increased in caliber by 2 to 3 mm but they are not frankly dilated. Spine:Patchy leptomeningeal enhancement along the surface of the cervical spinal cord is more conspicuous on the present study. This apparent difference may be due to technique and the presence of motion artifact on the prior exam, but disease was certainly present in a similar distribution before. Likewise, leptomeningeal enhancement along the surface of the thoracic cord, particularly the upper thoracic region, appears slightly more conspicuous. Patchy T2 signal alteration is also seen correlating to the upper thoracic disease.Patchy enhancement along the conus and nerve roots of the cauda equina is seen. No bulky intrathecal tumor deposits are suspected. This finding is progressed from the prior examination of April 2014 but at that time there was evidence of some mild leptomeningeal disease.Small foci of enhancement within the T9 vertebral body and left T9 pedicle are unchanged and nonspecific. An enhancing lesion within the T11 vertebral body is seen measuring up to 17 mm in diameter showing some degree of enhancement, T2 hyperintensity and T1 hypointensity. This lesion also has not significantly changed.Relatively mild degenerative disk disease is seen in the cervical and lumbar spine. This results in stenosis of the lower left sided cervical neural foramina. In the lumbar spine, there is scattered disk bulging and loss of disk height at L4-5 with scattered mild to moderate foraminal narrowing.Incidental note is made of a large lamellated infrarenal abdominal aortic aneurysm which measures 71 x 65 mm in maximal dimension. Cystic lesions are evident in the kidneys.
1. Interval placement of a ventricular catheter on the right. There is also a new right-sided subdural collection which follows CSF signal on all sequences. No findings are seen to suggest that this fluid is hemorrhagic and it may therefore reflect a subdural effusion or hygroma. This collection exerts mild mass effect on the right cerebral hemisphere.2. Since the prior examination, extensive confluent signal abnormality has progressed within the cerebral white matter. There is no associated mass-effect or enhancement. As such, these findings may represent a leukoencephalopathy related to chemotherapy and/or radiation. Findings are not typical for demyelination or infection and as such these are considered less likely possibilities.3. Leptomeningeal enhancement compatible with carcinomatosis is seen both supra- and infratentorially. The majority of this disease affects the cerebellum, but there are few scattered foci supratentorially and some of the cranial nerves are involved as discussed above. Overall, these lesions appear less well defined and some are smaller. Enhancement of the cranial nerves seems more intense, but this could be technical. No definite evidence of any new lesion is seen. Associated edema in the cerebellum has probably improved.4. Leptomeningeal disease along the surface of the spinal cord and cauda equina is seen. A similar pattern of disease was present on prior examinations, though the intensity of enhancement is increased on today's study. This may very well be due in part to technical differences, but some component of disease progression cannot be excluded.5. Enhancing foci within the T9 vertebral body are unchanged and nonspecific but could represent small metastases. A larger enhancing lesion within the T11 vertebral body is also nonspecific and unchanged, possibly representing an atypical hemangioma or a metastatic lesion.6. A very large infrarenal abdominal aortic aneurysm is noted incidentally.