74 years, Female, right weakness, history of breast cancer with metastasis to brain and seizures . Additional history per chart, patient is status post CyberKnife treatment for brain metastasis 5 months ago. Examination is obtained per treatment planning protocol and limited to 3-D T2 and 3D T1 sequences. There appears to be lack of contrast on the 3-D T1 sequence, which may be in part related to the low dose administered or timing. Fiducial markers are in place.There is a 15 x 17 mm lesion centered on the left precentral gyrus with extensive surrounding vasogenic edema. There is low T2 signal within the lesion which may reflect small amount of blood products or mineralization. There is mild effacement of the left lateral ventricle. No midline shift or herniation. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter as well as the pons are compatible with small vessel ischemic disease. No hydrocephalus. Major flow-voids are preserved.
1. Examination for operative planning demonstrating a 15 x 17 mm lesion in the left precentral gyrus consistent with known metastatic disease. 2. Note there appears to be lack of contrast on the 3-D T1 sequence and would suggest obtaining prior outside complete brain MRI with gadolinium to better assess for additional metastases.