Diagnosis: Secondary malignant neoplasm of brainClinical question: fallopian tube cancer with brain mets s/p whole brain radiationSigns and Symptoms: assess for EOD There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.There is T2 and FLAIR signal hyperintensity redemonstrated along the right anterior medulla. There is redemonstration multiple foci of enhancement associated with T2 hyperintensity and FLAIR hyperintensity in the posterior fossa. One in the right cerebellar hemisphere measuring 10 mm x 8 mm axial dimensions. It previously measured approximately the same dimensions. Another ring-enhancing lesion in the left cerebellar hemisphere measures 12 x 8 mm and previously measured similar dimensions. Another enhancing lesion is present in the midbrain and measures 11 x 16 mm axial dimensions and previously measured similar dimensions. Other lesions are also similar in size compared to the prior exam. The lesion located in the cerebellar vermis measures 7 x 9 mm in sagittal dimensions on the current exam and previously measured 12 x 10 mm.There are also multiple enhancing foci in the supratentorial brain which are less numerous than in the posterior fossa. One in the left parietal lobe along the precuneus measures 10 x 14 mm on the current exam and previously measured the same. It has a peripherally enhancing nodule associated with it other smaller lesions are scattered in the parietal lobes and right occipital lobe. Multiple punctate foci of enhancement are identified in the parietal and occipital lobes which were not as readily appreciated on the prior exam.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.There are multiple foci of enhancement scattered in the posterior fossa as well as supratentorial brain which are suspicious for metastatic disease. Compared to the October 28 exam there appears to be some minimal progression of some of the lesions and some regression of other lesions. Some but not all of the differences can be attributed to difference in scan technique between the two studies.2.Periventricular white matter lesions are attributable to posttreatment change.