Clinical question: Breast cancer with new brain metastases on CT. Signs and symptoms: These images, difficulty walking, left-sided weakness. Pre and postcontrast enhanced brain MRI:Examination demonstrates multiple supra and infratentorial enhancing tumors consistent with metastatic lesions. The largest lesion is in the cingulate generous of the right posterior frontal lobe. The lesion has a solid as well as multiple loculated cystic component and with evidence of internal hemorrhagic changes with enhancement. This tumor measures approximately at 32 x 46 x 32 mm in three transaxial dimensions. It demonstrate mild surrounding vasogenic edema and mass effect on the corpus callosum. The tumor minimally extends across the midline and likely through the falx to the left.There is a second superficially located left frontal metastatic tumor with enhancement measuring approximately at 12 x 12 x 16 mm. Minimal surrounding edema and regional mass effect is present. A third smaller metastatic lesion abutting the right falx in the left posterior parietal region and measuring 9 x 6 x 8 mm without appreciable surrounding edema or any significant mass effect.Additionally there is a parenchymal metastatic lesion in the right posterior cerebellum measuring 10 x 7.5 mm without surrounding edema or appreciable mass effect.Ventricular system are within normal size and without deviation of midline.The signal void of major intracranial arterial branches are identified.Calvarium and soft tissues of the scalp are unremarkable and without detectable abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.Paranasal sinuses demonstrate a small retention cyst in the dependent portion of right maxillary sinus and unremarkable otherwise.Pre- and post enhanced cervical spine MRI:Examination of cervical spine demonstrate normal signal intensity and alignment of the vertebral column and without evidence of osseous metastatic lesions. Signal intensity and caliber of the cervical cord is also within normal and without abnormal enhancement. No appreciable degenerative changes of cervical spine, no evidence of spinal stenosis or neural foraminal compromise at any level.Pre- and post enhanced thoracic spine MRI:There is normal anatomical alignment of the vertebral column.Examination demonstrates a single focus of marrow signal replacement with enhancement in the posterior left body of T10 vertebrae highly suggestive of a small focus of metastatic lesion. This finding is best appreciated on sagittal T1, sagittal T1 post enhanced on image 14.No convincing evidence of any additional foci of bone marrow signal change or enhancement. Signal intensity and caliber of thoracic cord remains within normal and without abnormal enhancement. There is a large cluster of enhancing pathologic lymph nodes in the mediastinum measuring 27 x 44 x 63 mm.Pre- and post enhanced lumbar MRI:Examination demonstrates normal anatomical alignment of the vertebral column and without intravenous fracture.There is diffuse uniform marrow signal replacement and enhancement of the vertebral body of L2 with involvement of bilateral pedicles and articulating facets consistent with metastatic lesion. Diffuse patchy foci of marrow signal replacement and enhancement is also noted involving vertebral body of L3 as well consistent with metastatic lesion. Normal signal intensity and caliber of the lower most visualized thoracic cord, conus and cauda equina without detectable abnormal enhancement.There are in addition multiple foci of marrow signal changes with enhancement involving the bilateral iliac wings consistent with metastatic lesions. The largest lesion on the left measures approximately at 19 x 11 mm in transaxial dimensions. The visualized lesions demonstrate no evidence of extraosseous spread of tumor.No appreciable degenerative changes of lumbar spine and no evidence of spinal stenosis or neural foraminal compromise.
1.Pre- and post enhanced brain MRI demonstrate multiple supra and infratentorial metastatic lesions as detailed/measured above. The largest lesion epicentered in the right posterior frontal cingulate gyrus and measuring at 32 x 46 x 32 mm.2.Pre- and post enhanced MRI of cervical spine demonstrate no evidence of metastases. No evidence of spinal stenosis or neural foraminal compromise.3.Pre and post enhanced MRI of thoracic spine demonstrate a single small metastatic lesion in the posterior vertebral body of T10 and unremarkable exam otherwise.4.Pre and post enhanced MRI of the lumbosacral spine demonstrate diffuse metastatic disease involving vertebral body and the posterior elements of L2 and to a lesser degree of L3 as detailed. Multiple osseous metastatic lesions of bilateral iliac wings are also noted. Unremarkable exam otherwise and without evidence of leptomeningeal enhancement, spinal stenosis or neural foraminal compromise.5.Incidental note is made of a large cluster of enhancing nodes in the mediastinum measuring at 27 x 44 x 63 mm as detailed.