Diagnosis: Malignant neoplasm of unspecified site of left female breastClinical question: History of brain mets please compare The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.There are punctate foci of susceptibility effect present in the cerebellar hemispheres bilaterally, right frontal lobe, left temporal lobe and the right occipital lobe which have been identified on prior exams and are best seen on the susceptibility weighted images. These are currently not associated with significant enhancement.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 demonstrate scattered opacities in the right mastoid air cells. The visualized portions of the orbits are intact.A focus of marrow replacement associated with some contrast enhancement in the left parietal calvarium is stable. A focus of marrow replacement along the left occipital condyle is also stable
1.Multiple lesions associated with blood products are present in the brain which are stable since prior exams. These most likely represent treated metastases.2.Calvarial lesions are reidentified and are also stable compared to the prior exam.