Male, 64 years old, history of poorly differentiated adenocarcinoma, likely salivary, status post CRT, with new brain metastasis on CT. Assess disease with attention to the skull base. Brain:A 13 x 10 mm ring-enhancing lesion is seen at the junction of the left occipital and temporal lobes. There is very mild local edema without significant mass effect.No additional intracranial enhancing lesions are seen. In particular, the cranial nerves and skull base foramina as visualized on this examination are within normal limits. No additional areas of parenchymal edema are demonstrated.There are numerous scattered small foci of white matter T2 hyperintensity, a nonspecific finding which has not significant changed from the prior examination. No intracranial hemorrhage or any abnormal extra axial fluid is detected. The ventricular system is normal in size and morphology.Cervical spine:Sagittal alignment of the cervical spine is within normal limits. Diffuse fatty marrow signal likely reflects prior radiation therapy.A region of T1 hypointense, T2 hyperintense enhancement within the right lateral aspect of the T2 vertebral body is seen. On comparison with recent prior CT, no destructive or lytic lesion is seen at this location, but rather, there are vertical striations which is a feature seen in benign hemangioma.Elsewhere, marrow signal characteristics are benign with no evidence of pathologic marrow enhancement.The visualized spinal cord demonstrates normal signal intensity throughout. No pathologic intraspinal enhancement is seen.C2-3: Facet hypertrophy. No significant spinal canal stenosis or neuroforaminal narrowing. C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild spinal canal stenosis. Moderate foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation. Moderate spinal canal stenosis. Moderate foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric to the left. Moderate spinal canal stenosis. Severe left and moderate right foraminal narrowing. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Severe left and moderate right foraminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.
1. A single metastatic lesion is seen at the junction of the left temporal and occipital lobes. This lesion causes very mild local edema and no significant mass effect.2. No definite evidence of metastatic disease to the cervical spine is seen. A region of signal abnormality and enhancement within the right lateral aspect of the T2 vertebral body is nonspecific but shows CT features compatible with a benign hemangioma. Continued follow-up is advised.