Diagnosis: Malignant neoplasm of breast (female), unspecified site. Secondary malignant neoplasm of brain and spinal cord(198.3)Clinical question: metastatic breast cancer please assess brain mets There is redemonstration of multiple ring-enhancing lesions enhancing lesions throughout the brain parenchyma. One located in the left cingulate gyrus measures 20 x 18 mm sagittal dimensions. One in the anterior left cingulate gyrus lesion measures 6 mm. One in the right basal ganglia measures 10 x 9 mm axial dimensions one in the left middle frontal gyrus measures 4 mm in diameter. One in the right post central gyrus close to the subcentral lobule measures 5 mm diameter. One in the right anterior temporal lobe measures 16 x 13 mm axial dimensions. One in the vermis currently measures 4 mm On the prior exam the right anterior temporal lesion measured 20 x 19 mm axial dimensions. The right basal ganglia lesion measured 12 x 9 mm axial dimensions; the left cingulate gyrus lesion measured 27 x 19 mm axial dimensions. The right postcentral gyrus lesion measured 8 mm; the smaller anterior left cingulate gyrus lesion previously measured 8 mm. The left middle frontal gyrus lesion previously measured 7 mm. The one in the vermis previously measured 4 mm.Compared to the prior exam the degree of vasogenic edema has regressed but not resolved.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 are clear. The visualized portions of the orbits are intact.
Since the prior exam multiple lesions scattered in the brain as detailed above have decreased in size and the associated vasogenic edema has regressed but not resolved. These are compatible with metastatic disease..