64-year-old female history of metastatic breast cancer. Evaluate for brain metastasis. No evidence of intracranial metastatic disease. No intracranial mass or mass effect. No abnormal parenchymal or meningeal enhancement to definitely indicate metastatic disease.There are multiple small enhancing osseous lesions appreciated along the right aspect of the calvarium, appearing similar to the prior bone scan. There is no intracranial extension. Tiny foci of decreased signal within the right frontal lobe on susceptibility weighted imaging are consistent with microhemorrhage and are associated with surrounding FLAIR hyperintensity and faint enhancment. Possible adjacent developmental venous anomaly.There are no areas of restricted diffusion to suggest acute ischemic infarct. The ventricles and sulci are symmetric. The basal cisterns are intact. Flow-voids are visualized within the intracranial vessels. The paranasal sinuses, mastoid air cells, and orbits are unremarkable.
1. No definite intracranial metastatic disease.2. Foci of microhemorrhage and mild surrounding FLAIR hyperintensity and faint enhancement in the right frontal subcortical white matter is nonspecific and may represent subacute to chronic ischemia or other injury. Vascular etiology is also possibility with presence of an adjacent developmental venous anomaly. Hemorrhagic metastasis is much less likely but consider follow-up evaluation.3. Small osseous metastatic lesions involving the calvarium which were also present on prior bone scan.