59-year-old female with bilateral leg weakness and bilateral horizontal segments. Evaluate for progress of metastatic disease. Brain MRI: There are multiple supratentorial and infratentorial intra-axial and extradural metastatic lesions with associated vasogenic edema, which have overall increased in size. The largest lesion, which is in the left cerebellopontine angle has also increased significantly in size. This lesion now measures 2.3 x 2.4 cm, compared to 1.5 x 2.2 cm previously. The surrounding edema which causes effacement of the fourth ventricle and mass effect on the adjacent brainstem. For reference, the largest lesion in the supratentorial brain is a left paramedian lesion measuring 1.9 x 1.9 cm, which has increased compared to 1.1 x 14.0 cm previously. Some of the smaller metastatic lesions demonstrate susceptibility abnormality, indicating probable previous hemorrhage. There is no evidence of acute infarct. The lateral ventricles and third ventricles remain unchanged in size compared to the brain MRI exam from 3/22/2016. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses are unremarkable. There is an enhancing subcentimeter right scalp nodule. Lumbar Spine MRI: There is no evidence of tumor within the lumbar spine. The vertebral column alignment is within normal limits. There are mild multilevel degenerative changes including endplate degenerative changes at the superior aspect of L1 and inferior aspect of T12 anteriorly. There is variable disc desiccation and disc height loss most prominently involving the T12-L1, L3-4 and L4-5 levels. There is a minimal to mild generalized disc bulge involving the L3-4 and L4-5 levels with at most minimal to mild spinal canal stenosis at the L3-4 level, There is no significant spinal canal stenosis elsewhere. However, there is mild bilateral neural foraminal narrowing at the L3 through S1 levels. There is enhancement within the anterior L3-4 and posterior L4-5 discs, which are likely degenerative in nature. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable. There is a partly imaged enlarged fibroid uterus.
1.Overall increasing size of the multiple supratentorial and infratentorial metastatic intracranial lesions. 2.Stable size of the lateral and third ventricles compared to the brain MRI from 3/22/2016.3.Mild multilevel degenerative spondylosis, but no evidence of metastatic disease involving the lumbar spine.4.Partly imaged enlarged fibroid uterus, which is better evaluated on the CT abdomen and pelvis from 5/20/2015.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.