82 years, Male, bladder cancer with leg weakness and asymmetric pupils.. There is a 9 x 9 x 9 mm enhancing lesion in the posterior right frontal lobe involving the medial aspect of the precentral gyrus. There is moderate surrounding T2/FLAIR signal abnormality related to vasogenic edema. There is mild local mass effect without midline shift or herniation. There is a faint 2 mm focus of enhancement involving the left anterior frontal lobe seen on post gadolinium axial series 1901 image 16 and post gadolinium 3-D series 2103 axial image 84. No additional abnormal parenchymal or meningeal enhancement is appreciated. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic disease. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear aside from mild opacification of the anterior ethmoid air cells. There is a small enhancing lesion involving the left frontal calvarium with associated diffusion abnormality suspicious for osseous metastasis.
1. 9 mm enhancing lesion in the right posterior frontal lobe involving the medial aspect of the precentral gyrus is most consistent with metastasis. There is surrounding vasogenic edema and local mass effect without midline shift or herniation.2. 2 mm focus of enhancement in the left anterior frontal lobe is suspicious for an additional metastasis but is less specific. Suggest attention on follow-up.3. Small focus of enhancement in the left frontal calvarium suspicious for osseous metastasis.4. Mild chronic small vessel ischemic disease.