52-year-old woman with metastatic breast cancer. Restaging exam.. There is diffuse, heterogeneous, enhancing abnormal marrow signal within the calvarium with areas of expansion that correspond to the lytic lesions seen on recent CT. There are multifocal areas of dural enhancement adjacent to the calvarial lesions, however, there is no dural nodularity or mass effect on the underlying brain. There is also an enhancing lesion within the clivus. The visualized upper cervical spine vertebrae are unremarkable.There is no abnormal intraparenchymal mass, mass effect, or areas of abnormal parenchymal enhancement. There are a few small areas of abnormal T2/FLAIR signal in the subcortical white matter which are nonspecific and may be related to mild chronic small vessel changes. No evidence of acute infarct. The ventricles and basal cisterns are normal in configuration. There is no midline shift or herniation. There is no evidence of intracranial hemorrhage or abnormal extra-axial collection.The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses are grossly unremarkable.
1.Innumerable calvarial metastatic lesions.2.Multifocal nonspecific areas of dural enhancement adjacent to the calvarial lesions which are favored to be reactive in etiology; dural invasion is less likely but can not be entirely excluded. 3.No intraparenchymal metastatic lesions, edema or mass effect.