58-year-old female with a history of lung adenocarcinoma presents with left-sided numbness and a hemorrhagic lesions identified on head CT, evaluate for brain metastases. There are several scattered ring-enhancing lesions throughout both cerebral hemispheres and in the cerebellar hemispheres with associated vasogenic edema. There is a bilobed ring-enhancing lesion in the right precentral gyrus measuring 15 x 14mm with surrounding vasogenic edema and punctate focus of susceptibility changes related to microhemorrhage. The lesion in the left parieto-occipital region in the periventricular white matter measures 11 x 19 mm also demonstrates subtle susceptibility effects and associated vasogenic edema. A small 4 mm lesion in the right coronal radiata, and 4 to 5 mm subtle enhancing lesion in the left middle frontal gyrus. In addition, there is a 8 x 7 mm enhancing lesion abutting the lateral margin of the left parieto-occipital fissure. A small 5 x 5 mm lesion is present in the left subcortical parietal lobe. There are 2 lesions measuring 5 mm and 6 mm in the right cerebellar hemisphere and 3 to 4 mm subtle enhancing lesion in the left cerebellar hemisphere.There is no evidence of acute infarct. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is a 9 mm enhancing lesion in the right frontal calvarium concerning for metastasis.
1.Several (at least 10) scattered supratentorial and infratentorial ring-enhancing lesions consistent with brain metastases.2. 9 mm enhancing lesion in the right frontal calvarium suspicious for osseous metastasis.