History of metastatic lung cancer with right hemiplegia. Evaluate for ischemia, structural lesion or metastasis. Brain: There is global parenchymal volume loss. There is no evidence of acute infarct, large intracranial mass, or mass effect. Again seen are scattered foci of susceptibility effect including the right frontal subcortical white matter, left inferior frontal lobe along the cortical surface, as well as in the left left paracentral lobule. Left inferior frontal focus corresponds to hyperdensity seen on CT likely representing calcification and less likely blood products given stability between 5/15 2015 and 5/20/2015. Remainder of the foci of susceptibility are compatible with chronic microhemorrhages or mineralization. There is mild associated FLAIR hyperintensity particularly with the left inferior frontal lesion which appears nodular. There are scattered foci of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is opacification of the left mastoid air cells.Cervical spine: Lack of contrast and motion degradation limiting evaluation for metastatic disease. There is minimal retrolisthesis of C5 on C6. At C5-6, there is disc bulge, mild loss of disc height and thickening of the ligamentum flavum, contributing to mild spinal canal stenosis and mild bilateral foraminal stenosis. There is abnormal marrow signal at the T1 and T2 vertebral bodies with involvement of the right-sided posterior elements of the T1-T3 vertebrae as well as the left T2 pedicle and T2 and T3 spinous processes. There is mild to moderate right foraminal stenosis at T1-T2 and T2-T3. The spinal cord displays normal signal and morphology. There is a small left pleural effusion. A nasoenteric tube is partially imaged.
1.No evidence of acute infarct. Please note lack of contrast limits evaluation for small metastatic lesions.2.Small foci of susceptibility effect described above in the right frontal lobe subcortical white matter and left paracentral lobule are compatible with chronic microhemorrhages or mineralization and possibly related to treated metastatic disease. Comparison with outside MRI studies would be helpful if available. There is an additional focus of susceptibility effect involving the cortical surface of the left inferior frontal gyrus which on MRI from 5/16/2015 appears to enhance although that examination is motion degraded. There is associated hyperdensity on recent CT which is favored to represent mineralization, perhaps due to treatment, or less likely minimal hemorrhage given stability between CT studies from 5/15/2015 and 5/20/2015. There is minimal associated nodularity and T2 signal compatible with mild edema or gliosis.3.Osseous metastases involving the T1-T3 vertebral bodies and posterior elements, contributing to mild to moderate right foraminal stenoses at T1-T2 and T2-T3.4.Degenerative changes of the cervical spine, most prominent prominent at C5-C6, with mild spinal canal stenosis and mild bilateral foraminal stenosis. No cord signal abnormality, high-grade spinal canal stenosis, or epidural tumor is appreciated within the limits of noncontrast study.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.