Female, 60 years old, history of metastatic breast cancer with right-sided headache and vision changes. Assess for metastases. On comparison with the prior examination, marrow signal intensity on precontrast images is somewhat diffusely lower than what was seen on the prior examination. This is particularly notable in the clivus, but the calvarium, occipital condyles, and visualized cervical spine also show similar features. These areas of marrow signal change show no evidence of frankly pathologic enhancement.A few scattered small T2 hyperintense lesions are evident within the cerebral hemispheres, unchanged. No parenchymal edema, mass effect or pathologic enhancement is seen. No acute intracranial hemorrhage or any abnormal extra axial fluid collection is detected. A focus of susceptibility along the posterior body of the left lateral ventricle is unchanged and of uncertain significance. Ventricular size and morphology are unchanged.
1. No definite evidence of brain parenchymal metastasis is seen. No findings to suggest leptomeningeal disease are evident.2. A generalized reduction in bone marrow signal intensity, most notable within the clivus, and could represent marrow reconversion secondary to treatment-related anemia, or perhaps a technical artifact due to differences in imaging parameters. The nondestructive and fairly uniform nature of these findings, along with lack of concerning findings in these areas on a recent PET CT, argue against bony metastatic disease. If clinical concern warrants, CT imaging can be considered to verify osseous integrity.