63 years, Female, altered mental status. History of metastatic breast cancer.. Evaluate for metastatic brain lesion. Brain: There is redemonstration of multiple heterogeneously enhancing lesions involving the calvarium similar to prior although markedly improved when compared to remote MRI brain study from 1/12/2015. The relatively largest of these lesions is seen involving the occipital bone with mild residual epidural extension and mass effect on the torcula herophili. There is no evidence of abnormal brain parenchymal enhancement or leptomeningeal enhancement.There is no diffusion abnormality. There is patchy periventricular white matter T2 hyperintensity stable to minimally increased since prior and likely related to posttreatment changes. The ventricles and sulci are unchanged in size and configuration. The cisterns remain patent. There is no midline shift or mass effect. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits.  There is trace fluid in the mastoid air cells and minimal mucosal thickening in the paranasal sinuses similar to prior. There is unchanged deformity of the right lamina papyracea with protrusion of the orbital fat compatible with chronic trauma. Cervical spine: Again seen are numerous areas of abnormal marrow signal and enhancement throughout the visualized cervical and thoracic vertebrae, including posterior elements. There has been decrease in enhancement associated with some lesions for example at the C2 level and the in the upper thoracic spine although there is increase in enhancement at the C4 and C5 levels. Confluent low T1 signal in the lower cervical and upper thoracic region related to diffuse tumor infiltration previously demonstrates an interval more heterogeneous appearance, likely reflecting treated tumor. A relatively large lesion involving the posterior elements of T1 has decreased in size. There is no abnormal leptomeningeal or epidural epidural tumor in the cervical spine. No cord signal abnormality. The cervical spine is in normal alignment, with straightening of the normal cervical lordosis. The vertebral body and disk heights are well-maintained. Minimal degenerative changes are seen at C3-C4, C5-C6, and C6-C7 levels without significant spinal canal or neural foraminal stenosis.
1. No evidence of intraparenchymal or leptomeningeal metastases in the brain. Again seen are multiple calvarial metastases similar to most recent prior, but much improved when compared to remote MRI study from 1/12/2015. There is minimal residual epidural extension in the occipital region surrounding the torcula Herophili without evidence of progression since prior from 2/27/2016.2. Stable to minimal increase in confluent FLAIR hyperintensity in the periventricular and subcortical white matter likely reflecting combination of posttreatment changes and chronic small vessel ischemic disease.3. Diffuse osseous metastatic disease in the cervical spine is again seen with overall improvement since 1/27/2015. There are areas of increased osseous enhancement as described above which are nonspecific in the setting of treated disease, and can be assessed with follow-up bone scans. There is however no evidence of epidural or leptomeningeal tumor or cord signal.