Altered mental status. History of lung cancer. Rule out brain metastasis. The study is moderately limited by patient motion.There are tiny, subtle foci of diffusion hyperintensity in the posterior left frontal deep white-matter (centrum semiovale), on the surface of the right cerebellar hemisphere and in the medial aspect of the right middle cerebellar peduncle with no associated contrast enhancement, which are suspected to represent subacute infarcts.A 4 mm focus of T1-hyperintensity in the left globus pallidus may reflect mineral deposition. A tiny (3 mm in diameter) focus of contrast enhancement to the right of midline in the pons is associated with susceptibility artifact but no perceptible abnormality on the other sequences and favored to represent incidental capillary telangectasia. Minimal periventricular T2/FLAIR hyperintense signal without diffusion restriction or contrast enhancement is nonspecific but most likely reflect chronic microvascular ischemia. The ventricles and the other CSF-containing spaces are mildly enlarged, reflective of global brain volume loss. There is no midline shift or brain herniation. There is no extra-axial fluid collection. Major intracranial vascular flow voids are preserved, reflecting gross vessel patency.There is moderate ethmoid and mild maxillary and sphenoid sinus mucosal thickening, associated with minimal fluid. This is nonspecific but in the proper clinical setting may reflect sinusitis. There is fluid in the mastoid air cells which is nonspecific. There is no gross orbital abnormality. There is an infiltrative, destructive, heterogeneously contrast enhancing mass involving the right lateral mass of C1 as well as the adjacent soft tissues. This lesion is not completely assessed or covered on this examination but involves the subjacent right lateral epidural space without mass effect on the spinal cord. In the axial plane, this contrast enhancing tissue measures up to 4.6 cm x 4.2 cm. Craniocaudad, it measures 2.6 cm. The mass is close proximity to the right vertebral artery (V3 segment), patency of which is not well assessed on this examination.
1.There is no convincing evidence of intracranial metastatic disease. Please note examination is motion degraded which limits evaluation for small lesions. As such follow-up study may be considered to better exclude the possibility of intracranial metastatic disease. 2.Few punctate foci of diffusion hyperintensity in the left frontal lobe and right cerebellar hemisphere/middle cerebral peduncle are suspected to represent subacute infarcts. 3.Enhancing mass involving the right lateral mass of C1 likely represents osseous metastasis. There is mild involvement of the right lateral epidural space at this level without mass effect on the cord. 