46 years, Female, history of colon cancer with brain metastases presented with altered mental status and one episode of seizure. Planned for whole brain radiation therapy tomorrow. Please note lack of contrast limits evaluation for metastatic disease. There is evidence of multiple lesions in the brain parenchyma which demonstrate enhancement on recent postcontrast CT from 11/27/2015. For example in the right inferior parietal lobule, there is a multilobulated lesion which measures approximately 18 x 19 mm as well as a an approximately 8 mm lesion in the left posterior temporal lobe. There is extensive surrounding vasogenic edema. Additional vasogenic edema is present in the bilateral frontal lobes and left parieto-occipital region which is not evident on recent CT, although differences in technique limiting precise comparison. Small left cerebellar lesion is also again noted. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Evidence of prior left-sided craniotomy is noted with subacute to chronic blood products in the left parietal lobe resection cavity deep to the craniotomy. There is no midline shift or herniation. Susceptibility sensitive sequence was not performed limiting evaluation for hemorrhage. Calvarium and extracranial soft tissues are grossly unremarkable aside from postsurgical changes.
1. Please note this examination is limited due to lack of contrast and motion degradation on multiple sequences. There are multiple lesions in the brain with surrounding edema which were demonstrated on recent postcontrast CT head dated 11/27/2015 and compatible with intracranial metastatic disease. FLAIR, SWAN, and postcontrast sequences were not acquired on the current study and patient should return for these sequences if possible.2. There is edema in the bilateral frontal lobes and left parieto-occipital lobes which was not appreciated on recent head CT. While it is possible this is related to differences in technique and small underlying metastatic lesions, possibility of a superimposed process such as posterior reversible encephalopathy (PRES) should also be considered. 3. No midline shift or herniation.4. Evidence of left parietal craniotomy with subacute blood products in the left parietal lobe deep to the craniotomy.