Reason: brain and spine mets History: gait ataxia, RUE weakness, lung CA. MRI Brain: Please note lack of intravenous contrast limits evaluation for metastatic disease. There is a 1.2 x 0.9 cm lesion, measured on the axial T2/FLAIR sequences, in the right parietal lobe with susceptibility effect indicative of blood products. There is extensive adjacent vasogenic edema involving portions of the the right frontal, parietal, and superior temporal lobes. There is significant mass effect with 5.4 mm midline shift to the left, not significantly changed compared to recent CT. There is no restricted diffusion to suggest acute ischemia. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI cervical spine:Vertebral body heights in the cervical spine are normal. There is mild reversal of cervical lordosis. Mild degenerative changes are seen throughout the cervical spine without high-grade spinal canal stenosis at any level. Postcontrast images are motion degraded however do not demonstrate suspicious enhancement to suggest osseous metastasis, epidural tumor, or cord lesion.Multilevel degenerative changes, as described below: At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. Minimal disc osteophyte complex.At C4-5 there is a small disc osteophyte complex with effacement of the ventral thecal sac. No significant spinal canal stenosis. Mild bilateral neural foraminal narrowing.At C5-6 there is a small disc osteophyte complex with effacement of the ventral thecal sac. No significant spinal canal or neural foraminal stenosis. At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or right neural foramen. There is uncovertebral hypertrophy on the left and facet arthropathy resulting in mild left neural foraminal narrowing.Paraspinal soft tissues are unremarkable.
1. Please note lack of postcontrast brain MRI sequences limits evaluation for metastatic disease. There is a 12x9 mm hemorrhagic lesion in the right parietal lobe with extensive surrounding vasogenic edema presumably representing metastasis given history. Suggest post contrast brain MRI for further evaluation including evaluation for additional lesions. There is mass effect related to the extensive edema with 5 mm leftward midline shift.2. Postcontrast images of the cervical spine are motion degraded but demonstrate no evidence of metastatic disease. There are mild degenerative changes without significant spinal canal stenosis at any level. No cord signal abnormality. Individual levels as above.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.