44 years Female (DOB:10/10/1971)Reason: evaluate for mets History: hx of CAPROVIDER/ATTENDING NAME: HEMAL M. NAYAK HEMAL M. NAYAK There are multiple foci of diffusion restriction present particularly in the watershed zone between the anterior middle cerebral arteries bilaterally but also along the left superior frontal gyrus and left cuneus and paracentral lobule. Many of these display contrast enhancement following gadolinium administration. Additional small patchy foci of diffusion restriction are present in the cerebellum predominantly in the inferior aspect of the left cerebellar hemisphere but also present in the right cerebellar hemisphere. A couple of these lesions display microhemorrhages.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.
1.Multiple patchy foci of diffusion restriction suggestive of metastatic disease are present diffusely in the brain in the mixed watershed and small embolic pattern of distribution. Many of these are associated with contrast enhancement suggestive of subacute phase. Please note that this reduces the detection rate for metastatic disease. If there is clinical suspicion for metastases a follow-up exam would help assess this further.