 There are numerous infiltrative enhancing lesions throughout the calvarium as well as in the visualized cervical spine at C1 and C2. The largest lesion is located within the frontal bone, predominantly on the left, and has a 7-mm thick component of scalp soft tissue extension along the left forehead extending posteriorly. There is also extension into the left frontal sinus as well as mild epidural extension with thickening and enhancement of the abutting dura. There is mild mass effect on the adjacent left frontal lobe.In addition, there is a relatively large right occipital enhancing lesion with scalp soft tissue and mild epidural extension. There are numerous patchy foci of T2 hyperintensity within the supratentorial and infratentorial white matter including the brainstem that are most compatible with chronic small vessel ischemic disease. There is no evidence of intraparenchymal mass or acute infarct. There is a punctate focus of susceptibility effect within the left parietal lobe which may be related to a prior chronic microhemorrhage. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. There is fluid within the left mastoid air cells suspected to be related to an adjacent left temporal bone lesion..
1.Numerous calvarial metastases with scalp soft tissue and intracranial epidural extension. There is enhancement of the dura particularly in the left frontal and right parieto-occipital regions which may be reactive or represent early dural invasion. There is mild mass effect on the left frontal lobe. In addition, there is invasion of the left frontal sinus. 2.There is no evidence of intraparenchymal metastases. 3.Metastatic lesions also seen at C1 and C2 in the cervical spine without mass effect on the visualized cervical cord.4.Fluid within the left mastoid air cells may be related to left temporal bone lesion.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.