Clinical question: Brain metastases. Signs and symptoms: Breast cancer. Pre-and post enhanced CT of brain:100 cc of Omnipaque 350 was administered.Examination demonstrates diffuse subcortical and periventricular areas of low-attenuation which considering patient's age are suspected for advanced small vessel disease of indeterminate age. There is subtle ex vacuo dilatation of the lateral ventricles. There is no evidence of intracranial hemorrhage, edema or mass effect, midline shift or hydrocephalus.There is no evidence of any abnormal enhancement of renal parenchyma or the leptomeninges on post infused images to suggest for metastatic lesions.The calvarium is intact.Limited views of the orbits are unremarkable.Visualized portions of paranasal sinuses and mastoid air cells are unremarkable.Enhanced CT of cervical spine:Examination of the lower cervical spine is severely limited due to excessive artifact from patient's shoulders.Examination demonstrates extensive destructive changes involving vertebral body and the posterior elements of C7 vertebrae as was noted on prior MRI examination. Sagittal reformatted images demonstrate more than 50% compression deformity of C7 vertebrae and antral listhesis of C6 on C1. The destructive bony lesion involves the bodies, pedicles, right facets and lamina and the spinous processes of C7. Assessment for spinal canal stenosis cannot be made due to excessive artifact. Compared to prior MRI examination or were no gross interval change in the degree of subluxation is seen.Osteolytic changes of vertebral body of C6 is also suspected.Due to suboptimal quality of images possibility of additional metastatic lesions cannot be ruled out.Please refer to MRI examination of cervical spine from 12 -- 29 -- 2010 for further information. Follow up with a repeat MRI exam is recommended if surgical intervention is contemplated.Extensive degenerative changes of the cervical spine with resultant multilevel significant neural foramina compromise at C3 -- C4, C4 -- C5 and C5 -- C6 level are noted.
1.Pre-and post enhanced head CT demonstrates no evidence of metastatic disease. Advanced small vessel disease of indeterminate age is noted.2.Suboptimal enhanced CT of cervical spine due to extensive streak artifact from patient's shoulders. Three visualization of the destructive metastatic lesion involving the body and the posterior elements of C7 and body of C6 vertebrae as described above. Recommend further follow-up with an MRI examination for assessment of any interval change since prior MRI examination of 12 -- 29 -- 10.