 Images are somewhat limited by patient motion, especially on postcontrast images, particularly the 3-D T1 post contrast images. Within these limitations, there has been interval decreased size and conspicuity of multiple scattered intra-axial enhancing supratentorial metastases compared to the prior MRI, consistent with the improved appearance of areas of associated low density vasogenic edema on recent CT. For example, the previously referenced left inferior parietal lobule lesion now measures 4 x 6 mm on 13 101/25, compared to previous remeasurement of 6 x 11 mm on prior 10/11. There is slight increased conspicuity of susceptibility associated with a right posterior frontal subcortical lesion which may indicate minimal microhemorrhage. Overall, extensive abnormal T2/FLAIR hyperintensity surrounding enhancing lesions is decreased, with decreased localized mass effect.The ventricles and sulci are prominent, consistent with mild-moderate age-related volume loss. The basal cisterns remain patent. There is no midline shift. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with moderate chronic small vessel ischemic changes. There is no new pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. Fluid opacification of right much greater than left mastoid air cells is noted.
1.Motion limited 3-D T1 post contrast images, although with overall improved appearance of scattered metastatic lesions and decreased associated vasogenic edema.2.Slight increased conspicuity of susceptibility associated with a right posterior frontal lobe white matter metastatic lesion which may indicate minimal interval microhemorrhage.3.Stable underlying moderate chronic small vessel ischemic changes.