Female 66 years old with history of papillary thyroid cancer metastatic to lung, bone, and liver and history of psychogenic seizures, concern for brain metastasis. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. There is no abnormal intracranial enhancement. Mild ventricular and sulcal prominence is consistent with age-related volume loss, while mildly increased T2/FLAIR signal within the subcortical and periventricular white matter consistent with chronic small vessel ischemic changes. There is no midline shift or herniation.Nonenhancing oval T2 hyperintense and T1 hypointense left parotid lesion measuring 12 x 16 mm with possible single thin septation noted on coronal images, has increased in size from prior remote measurements of 8 x 6 mm (10/18/2012). It appears similar in overall size when compared to the more recent CTs. The lesion causes mild localized mass effect on the adjacent parotid tissue and demonstrates a small area of apparent increased signal in the anterior aspect on early postcontrast images; however, the signal is not present on delayed post contrast images and is thus likely artifactual in nature. Overall, the parotid glands have a nodular appearance, which is nonspecific and may be posttreatment or autoimmune in nature. A asymmetrically prominent tubular structure is noted along the anterolateral aspect of the right masseter, which may represent asymmetric prominence of the duct.Symmetric prominence of the superior ophthalmic veins incidentally noted. The major cerebral flow voids are intact. Left anterior frontal T1 and T2 hypointense marrow lesion with minimal thin peripheral enhancement, which corresponds to a sclerotic lesion on CT, and appears unchanged when compared to baseline exam in 10/21/2002 and is likely a benign bone island. T2 hypointensity corresponding to an area of hyperattenuation on prior CT within the right anterior frontal scalp, which probably represents an area of scarring. The orbits and paranasal sinuses are grossly unremarkable.
1) No definite intracranial metastases identified.2) Redemonstration of oval left parotid lesion, which has doubled in size from prior remote exam dated 10/18/12, and may represent a non-aggressive primary parotid lesion such as a pleomorphic adenoma or Warthin tumor, although developmental cyst remains in the differential, as does necrotic metastatic disease but less likely given slow change.3) Asymmetric right parotid duct of uncertain clinical significance, correlate for recent inflammatory or obstructive pathology.4) Mild chronic small vessel ischemic changes.