Diagnosis: Malignant neoplasm of upper-outer quadrant of unspecified female breastClinical question: Hx: metastatic breast cancer, on letrozole therapySigns and Symptoms: dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are couple nonenhancing foci of marrow replacement along C2 one of which is in the odontoid process.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There is no evidence for brain metastases.2.There are a couple nonenhancing foci of marrow replacement in the visualized C2 vertebra associated with a relatively mottled appearance within the calvarium. These are suspicious for bone metastases which are potentially treated. Please correlate with patient's bone scan for further comments.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 