 This exam is mildly degraded by motion artifact.BRAIN: There are two adjacent peripherally enhancing lesions within the right frontal lobe that measure 19 x 22 mm and 20 x 22 mm. There is extensive surrounding edema. Within the left frontal lobe there is a peripherally enhancing cystic mass that measures 40 x 41 mm with a enhancing nodule in the anterolateral portion that measures 26 x 12 mm. There is extensive surrounding edema that results in minimal rightward subfalcine herniation and partial effacement of the bilateral lateral ventricles. No uncal herniation.There is a punctate focus of susceptibility effect within the right parietal lobe as well as small foci within the lesions. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are unremarkable. SPINE: Motion degradation slightly limits evaluation. There is a new 21x8mm (axial plane) extramedullary mass within the right aspect of the spinal canal at the C4 level extending out of the right neural foramen and compressing the spinal cord; mass measures 22 mm in the craniocaudal dimensions. C5 osseous metastatic lesion again seen.At the level of T8 there is an intramedullary mass which measures 8 x 11 x 31 mm in the AP x transverse x craniocaudal dimensions. There is T2 hyperintensity within the spinal cord extending from the C3 through T11 levels. There is a new T1 hypointense and enhancing lesions within the T4 vertebral body. Previously seen small T2 vertebral body lesion now demonstrates T1 hyperintensity likely related to treatment. There is increased T1 hyperintensity involving the T3 vertebral body, also compatible with treatment. Small mild T1 hyperintense lesion involving the T8 vertebral body, may represent hemangioma. No associated compression fractures are dorsal epidural extension. Small left paracentral disk protrusions are again seen noted at the T6-7, T7-T8, and T8-T9 levels. There is a 8 x 5 mm new intradural enhancing lesion at the L5 level involving or adjacent to the descending right S1 nerve root, There is unchanged mild wedge compression deformity of the L1 vertebral body with heterogeneous signal and an interval decrease in edema and enhancement. No new osseous lesions in the lumbar spine.
1.Three large intracranial metastases with surrounding edema and minimal midline shift.2.New intramedullary spinal cord mass at the T8 level likely represents a metastasis. There is extensive edema throughout the spinal cord.3.New extramedullary spinal mass at the right C4 level extending into the right C4-5 neural foramen. There is resulting cord compression.4.New intradural enhancing lesion at the L5 level involving the traversing right S1 nerve root also compatible with metastasis.5.New osseous metastases at the T4 vertebral body without compression deformity. Pathologic compression fracture involving the L1 vertebral body again seen with interval decrease in edema and enhancement.Findings called to Dorota Havlin at 5:00pm on 1/12/15. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.