Clinical question: 76-year-old male with prostate cancer with dural metastases. Signs and symptoms: Dural metastases. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates stable focus of encephalomalacia and gliosis in the left posterior temporal/occipital lobe with associated ex arcuate dilatation of left temporal horn and trigone of lateral ventricle consistent with chronic ischemic stroke.Stable diffuse foci of marrow signal changes and subtle enhancement involving the left temporal and left parietal calvarium. Findings represent a constellation of postoperative changes and/craniotomy site and metastases/treated metastatic changes without appreciable change since prior exam.Stable patchy foci of FLAIR and T2 hyperintensity primarily in the periventricular white matter of bilateral cerebral hemispheres highly suggestive of chronic small vessel ischemic strokes.More confluent foci of FLAIR hyperintensity in the periventricular white matter of bilateral cerebral hemispheres surrounding the trigone of lateral ventricles (left greater than right) is likely secondary to treatment/radiation changes and overlapping small vessel ischemic strokes.Ventricular system remains stable in size and maintain midline.There is no detectable parenchymal abnormal enhancement or evidence of parenchymal vasogenic edema.Unremarkable signal intensity of the calvarium and without enhancement other than the above-mentioned changes in the left temporal/parietal region.Unremarkable images through the orbits. All visualized paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.
1.No evidence of an acute intracranial process and no convincing evidence of new findings since prior study. 2.Marrow signal changes of left temporal and parietal calvarium with faint enhancement representing constellation of postoperative/craniotomy and metastatic/treated metastatic lesion without interval change. Unremarkable signal intensity of the calvarium otherwise and without abnormal enhancement.3.Stable patchy foci of periventricular T2/FLAIR hyperintensity representing post treatment/radiation change and chronic small vessel ischemic strokes.4.Stable foci of encephalomalacia and gliosis in the left posterior temporal-parietal without abnormal enhancement as detailed.