 Foci of enhancement measuring less than 5 mm in the right insula, as well as other punctate foci in the anteromedial and lateral right superior frontal gyrus, and the left pons are unchanged. These are associated with susceptibility effect indicative of hemorrhagic metastases. There are no new foci of susceptibility effect or new suspicious intra-axial enhancement. There is no acute infarct, mass effect or midline shift. There are mild periventricular and subcortical white matter T2 hyperintensities which are nonspecific and likely represent chronic microvascular ischemic changes.There are several scattered calvarial enhancing lesions again seen as well as one involving the right mandibular condyle. There is diffuse worsening of T1 hypointensity involving the visualized upper cervical spine as well as the bilateral occipital condyles. There is increased enhancement involving the clivus.
1. No significant change in subcentimeter enhancing metastatic lesions within the brain parenchyma. No significant edema or mass-effect with any of the lesions. 2. Scattered small enhancing lesions in the calvarium are not significantly changed. There is more diffuse worsening of bone marrow signal abnormality involving the upper cervical spine as well as the occipital condyles which can be seen with marrow reconversion (such as with treatment with hematopoietic growth factors), although progression of osseous metastasis remains a less likely possibility.