Diagnosis: Malignant neoplasm of brain, unspecifiedClinical question: increased tumor burdenSigns and Symptoms: lethargy There is redemonstration of a multiple foci of enhancement scattered throughout the brain. The largest one is located in the right frontal lobe which includes part of the prefrontal gyrus and measures 44 x 30 mm in axial dimensions and has a irregular ring-enhancing pattern. It is high signal on FLAIR and T2 and low signal on T1. This is stable and compared to the prior exam.There is punctate enhancement present within the corpus callosum associated T1 signal hyperintensity and ring enhancement as well as some susceptibility artifact. These are stable and compared to the prior exam.A left occipital lobe focus of abnormal enhancement is present which measures 36 x 24 axial dimensions on postcontrast imaging and 24 x 39 mm on FLAIR imaging. It is slightly larger on the current exam when compared to the prior exam where it measured approximately 20 x 37 mm axial dimensions on FLAIR imaging and 18 x 36 mm on postcontrast imaging.There is a lesion located at the left thalamus and posterior limb of internal capsule extending to the centrum semiovale measuring 18 x 12 mm which appears stable and enhances subtly following gadolinium administration. A similar lesion is present at the right globus pallidus and Jan of internal capsule and measures 16 x 11 mm and is also unchanged but does not enhance following gadolinium administration.There is redemonstration of a calvarial-based focus of ring enhancement located in the right frontal bone which measures 14 mm axial dimension and previously measured the same. It is best seen on the prior head CTs and appears like a burr hole.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.The current exam is compromised due to patient motion.
1.Since the prior examination multiple brain parenchymal lesions appear similar in dimensions. Some of the corpus callosum lesions are hemorrhagic. A left occipital lesion appears slightly larger on the current exam when compared to the prior exam. These lesions are suspicious for malignancy.2.There is a calvarial-based lesion present at the right frontal bone just anterior to the coronal suture. This most likely represents a prior burr hole.3.Exam is somewhat compromised due to patient motion which may obscure more subtle abnormalities.