Secondary malignant neoplasm of brain [C79.31] / Malignant neoplasm of prostate [C61], Reason for Study: ^Reason: 67 yo M with metastatic prostate cancer, prior cavernous sinus XRT, now with worsening aphasia/apraxia and right lower extremity spasms. Interval progression of enhancing bi-convexity and left frontal dural based masses in terms of size and extent since prior scan. In addition, underlying brain edema in particular bilateral frontal and parietal lobes are shown. On gradient echo images, peripheral aspects of the left parietal dural lesion show some susceptibility artifacts, however, these lesions could represent compressed adjacent cortical veins but can also represent intralesional hemorrhages.Irregular diffuse bihemispheric dural enhancements indicate diffuse dural involvement of metastatic lesions.Previously shown left Meckel's cave and trigeminal ganglion lesions are not conspicuous on today's scan. Normal fatty marrow signal intensities of clivus, skull and upper cervical vertebral bodies appear to be replaced with low signal intensity lesions suggesting diffuse bone marrow metastasis. However, this could also represent early changes of radiation. There is no evidence of acute ischemic lesion.The ventricles, sulci and cisterns are symmetric and unremarkable. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear.Retention cyst in the right maxillary sinus.
1. Interval progression of bihemispheric dural metastatic lesions with underlying brain edema since prior scan.2. Interval decrease size of the left Meckel's cave and left trigeminal ganglion lesion since prior scan.