Reason: Concern for worsening metastatic disease History: Headache, history of metastatic breast CA status post WBRT The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an enhancing lesion measuring 8 x 5 mm axial dimensions located in the left hand motor area of the precentral gyrus which previously measured 9x7mm. There is redemonstration of a couple punctate enhancing lesions in the right inferior parietal lobule which appears smaller on the current exam they currently measure 2 mm and previously measured 4 mm. One of these inferior parietal lobule lesions is associated with signal loss on susceptibility imaging which would suggest a microhemorrhage (this has not changed). There is redemonstration of a left temporal lobe lesion in the fusiform gyrus which previously measured 6 mm and now measures 3 mm. There is redemonstration of a right cerebellar lesion measuring 2 mm in size measuring about the same on the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.Multiple punctate lesions scattered in the brain parenchyma compatible with metastases - as detailed above - are smaller on the current exam when compared to the prior exam from December 2014.