Clinical question: History of metastatic breast cancer, presents with seizure-like activity, please assess for brain metastases. Signs and symptoms: Rule out brain metastases. Nonenhanced brain MRI:Negative diffusion weighted series.There is normal anatomical morphology and signal intensity of brain parenchyma on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination. There is no finding to suggest presence of a metastatic disease on the nonenhanced series.The signal void of major intracranial arterial branches are identified. The calvarium demonstrates multiple varying-sized foci of T2 hypointensity without interval change since prior exam and consistent with multiple sclerotic calvarial metastases. None of the lesions demonstrate any extra osseous components.Unremarkable images through the orbits. All paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.
1.Multiple sclerotic calvarial metastatic lesions without change since exam.2.No detectable parenchymal metastatic lesions on this nonenhanced exam.