Evaluate for new intracranial metastasis. History of renal cell carcinoma. There are innumerable enhancing lesions involving the cerebrum, cerebellum and brainstem, some of which are cavitating. The largest cavitating lesion is located within the right perirolandic region and measures 12 x 10 mm (series 101, image 22). The largest non-cavitating lesion measures 7 x 5 mm, located within the right middle temporal gyrus. There is extensive vasogenic edema associated with these enhancing lesions, most confluent within the right temporal, parietal and bilateral frontal lobes. There is local mass effect, but no midline shift or herniation. There are scattered foci of microhemorrhage throughout the brain parenchyma, some associated with the metastases. No definite left meningeal enhancement is identified.There are multiple enhancing calvarial lesions, the largest within the right frontal bone measures 22 x 11 mm and extends through the outer table of the skull into the diploic space.There is no evidence of acute infarct. An empty sella is incidentally noted. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. There is mild asymmetric increased fluid distension of the distal optic nerve sheath on the right. The orbits are otherwise unremarkable.
1.Diffuse supratentorial and infratentorial enhancing lesions, compatible with significant burden of metastases, some of which are cavitating and others associated with hemorrhage. There is extensive associated vasogenic edema and local mass effect, but no midline shift or herniation.2.Multiple enhancing calvarial lesions, also compatible with metastases.