Clinical question: Stage IV melanoma brain metastases. Status post treatment. Signs and symptoms: Restaging. Pre and post enhanced brain MRI:Examination demonstrates a previously known right paramedian occipital lobe metastatic enhancing lesion with interval decrease in size since prior study. The finding measures approximately 9 x 6 mm in transaxial dimensions compared to prior study measurement of approximately 15 x 11 mm. Similar to prior exam there is extensive internal susceptibility signal changes of tumor. There is no detectable surrounding vasogenic edema and no appreciable mass effect.There is no convincing evidence of any additional foci of parenchymal, leptomeningeal or calvarial enhancement suggest metastatic lesions.Unremarkable cerebral cortex, cortical sulci, ventricular system and CSF spaces. There are multiple tiny periventricular and subcortical foci of FLAIR hyperintensity without significant change since prior exam and suspected of mild chronic nonhemorrhagic small vessel ischemic strokes.Pre and post enhanced cervical MRI:The signal intensity of the vertebral column is unremarkable other than minimal changes secondary to degenerative disease.The alignment of vertebral column is anatomical.There is no detectable abnormal enhancement or vertebral column to suggest metastatic disease.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord without abnormal enhancement.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild asymmetric left-sided facet hypertrophic changes with mild left neural foraminal compromise and unremarkable otherwise.C4-C5 demonstrate moderate disc disease and loss of disc height, mild bilateral facet and minimally of ligamentum flavum hypertrophy is noted. There is shallow broad-based origin disc. Constellation of above changes results in significant right and mild left neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate mild disc disease and loss of disc height, mild bilateral facet (left greater than right) hypertrophy. No spinal stenosis or neural foraminal compromise.C6-C7 demonstrate advanced disc disease and loss of disc height, shallow ventral broad-based bulge and hypertrophic spur, moderate bilateral facet hypertrophy changes and mild ligamentum flavum hypertrophy. Constellation of changes results in mild bilateral neural foraminal compromise and without convincing evidence of central spinal stenosis.C7-T1 is unremarkable.
1.Interval decreased size of a right paramedian occipital metastatic lesion to 9 x 6 mm compared to prior study measurements of 15 x 11 mm. No surrounding edema or mass effect.2.Negative diffusion weighted images and findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.3.Pre and post enhanced MRI of cervical and upper most visualized thoracic spine demonstrate no evidence of osseous, cord or meningeal metastases. Degenerative changes of cervical spine results in mild central spinal stenosis at C4-C5. Multilevel neural foraminal compromise (some significantly) as detailed per level above.