Diagnosis: Secondary malignant neoplasm of brain and spinal cord Malignant neoplasm of thyroid glandClinical question: history of papillary thyroid carcinoma previously treated with radiosurgery; please evaluate response (particular attention to enlarging L superior parietal region)Signs and Symptoms: brain metastases. The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post left-sided craniotomy. There is adjacent dural thickening present and blood products. A previously noted mass in the left inferior parietal lobule is not readily identified on the current exam. Instead there is a small amount of enhancement associated with the susceptibility effect indicative of postsurgical change.There is a 6 mm ring-enhancing lesion present along the left superior parietal lobule just behind the left postcentral gyrus. This measured 8 mm on 5/29/2015 and 6 mm on the 6/23/2015 exam.There is redemonstration of a 3 mm enhancing longitudinal along the lateral aspect of the right orbital gyrus. This area is obscured on susceptibility weighted imaging.A 2 mm minimal nodule is redemonstrated at the frontal horn of the right lateral ventricle. It is barely visible on the current exam and was more conspicuous on the prior exam. It is associated with the susceptibility effect and is more conspicuous on the susceptibility weighted images on the current exam.A 2 mm nodule is present along the right inferior frontal gyrus. It is associated with the susceptibility effect.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 demonstrate scattered opacities. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.The patient has undergone surgical removal of a left inferior parietal lobule mass.2.There are multiple small nodules scattered in the right frontal lobe, left parietal lobe and left frontal lobe. There appear to be blood products associated with these lesions which make the somewhat more conspicuous on susceptibility weighted imaging in areas where there is less artifact from the skull base. In general these lesions appear stable compared to the 6/23 exam but slightly smaller compared to the 5/29 exam.