Metastatic breast cancer. Baseline exam prior to enrolling in a clinical trial. Evaluate for brain metastasis.. There is a peripherally enhancing T1 hypoattenuating and T2 hyperattenuating mass in the right frontal lobe measuring up to 42 mm with surrounding vasogenic edema and mass effect upon the frontal horn of the right lateral ventricle. There is susceptibility effect within the dominant mass, likely related to hemorrhage. In addition, there is an enhancing lesion in the left frontal lobe up to 5 mm, an enhancing lesion in the right anterior parietal lobe that measures up to 7 mm, and a right cerebellar enhancing lesion that measures up to 4 mm. There leftward midline shift measuring up to 3 mm anteriorly with slight subfalcine herniation. Thre is also effacement of the frontal horn of the right lateral ventricle. Within the posterior aspect of the pons, there appears to be a punctate focus of diffusion restriction. The major cerebral flow voids are intact. There appears to be a punctate focus of enhancement in the right posterior globe. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. There are bilateral nasolabial fold cosmetic fillers.
1. A total of four supratentorial and infratentorial lesions likely represent metastases, the largest of which measures up to 42 mm in the right frontal lobe with vasogenic edema, possible intratumoral hemorrhage, and 3 mm of midline shift. 2. A punctate focus of enhancement in the right posterior globe may also represent a metastasis. 3. Possible punctate recent infarct in the right pons.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.