66 years, Female, upper extremity weakness with the known bone metastases secondary to thyroid cancer. Rule out cord compression.. Brain: There is evidence of intracranial metastatic disease. There is a heterogeneously enhancing lesion involving the left posterior frontal lobe cortex including the precentral gyrus which demonstrates cystic and solid components. There is mild surrounding edema. The lesion measures up to 29 mm in the longitudinal dimension and 12 mm in the AP dimension. There is also a cortical lesion involving the left occipital lobe with similar heterogeneous enhancement and measuring approximately 14 x 14 mm. There is more faint ill-defined enhancement immediately lateral to this lesion with restricted diffusion. There are multiple additional foci of restricted diffusion including the cortex of the bilateral frontal lobe as well as additional scattered foci in the bifrontal periventricular white matter and the left splenium. There is minimal associated enhancement. There is susceptibility associated with the above-mentioned larger left posterior frontal and left occipital lesions compatible with hemorrhagic metastases.There is no midline shift or herniation. No hydrocephalus. Major flow-voids in the brain are preserved. There is a 16 x 12 mm ovoid cystic lesion involving the left parotid gland which is unchanged since prior from 11/24/2015 and larger since CT dated 10/18/2012; differentials again include developmental cyst, low-grade cystic neoplasm, or focal ductal dilatation. Calvarium and remainder of the extracranial soft tissues are grossly unremarkable.Cervical spine: Vertebral body heights are normal. There is straightening of the cervical spinal curvature. Alignment is otherwise grossly maintained. No abnormal enhancing foci are appreciated. There is focus of low T1 and low T2 signal involving the right inferior lateral aspect of the C4 vertebral body corresponding to foci of air as seen on prior CT studies and favored to be on a degenerative basis. The spinal cord is of normal caliber and signal. There is no pathological enhancement.Multilevel degenerative changes are seen including disc bulges throughout the cervical spine with mild spinal canal narrowing from C3-C4 to C5-C6. No high-grade spinal canal stenosis is appreciated. Mild to moderate multilevel neural foraminal narrowing is noted related to uncovertebral hypertrophy and facet arthropathy, relatively worse at the left C4-C5 and C5-C6 levels. Small subcutaneous lipoma is incidentally noted in the posterior subcutaneous soft tissues on the left at the C5-C6 level.Thoracic spine: The thoracic spine is in normal alignment, with a normal thoracic kyphosis. The vertebral body heights are well maintained. No worrisome focal marrow signal abnormality is appreciated. Scattered foci of T1 hyperintensity are compatible with small hemangiomas. Image quality is suboptimal due artifact however no obvious cord signal abnormality is appreciated. There is no pathological enhancement. Mild multilevel degenerative changes are present including disc height loss, small multilevel disc bulges, ligamentum flavum thickening, and mild facet arthropathy. No significant spinal canal or neural foraminal stenosis is appreciated.Multiple lung nodules related to metastatic disease are noted and better assessed on recent dedicated chest CT.
1. Multiple enhancing lesions in the brain, particularly involving the left posterior frontal lobe and left occipital lobe, are most consistent with intracranial metastatic disease. There is evidence of hemorrhage associated with these two larger lesions. There is mild associated edema. No significant intracranial mass effect, midline shift, or herniation. 2. There are multiple foci of restricted diffusion in the brain associated with mild enhancement. Notably there is restricted diffusion in the left occipital lobe just lateral to the enhancing left occipital metastasis described above. These findings suggest infarcts associated with the intracranial metastases and raise suspicion for tumor embolism.3. No evidence of metastatic disease in the cervical or thoracic spine. There is mild spinal canal stenosis in the cervical spine at C3-C4, C4-C5, and C5-C6, which is on a degenerative basis. No evidence of high-grade spinal canal stenosis, cord compression, or cord signal abnormality.