Diagnosis: Secondary malignant neoplasm of brainClinical question: 75 yo F with hx of metastatic breast cancer s/p SRS, eval for new metsSigns and Symptoms: none The CSF spaces are appropriate for the patient's stated age with no midline shift. There is redemonstration of an irregularly-shaped enhancing focus located in the right precentral gyrus measuring 14 x 9 mm axial dimensions which previously measured approximately the same dimensions. It is associated with some susceptibility effect, loss of volume and surrounding FLAIR and T2 signal hyperintensity. The T2 and FLAIR signal hyperintensity remains stable. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. A couple small enhancing foci present along the inferior aspect of the left cerebellar hemisphere one measuring 4 x 6 mm and the other one measuring 6 x 4 mm. On the prior exam these were not readily visible.There is a 3 mm enhancing focus present along the right cuneus which was not readily visualized on the prior exam.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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.Since the prior exam the patient has developed a new lesions in the right cuneus and the left cerebellar hemisphere inferiorly. These are compatible with metastatic disease.2.A lesion in the right precentral gyrus remains stable and compared to the prior exam and is status post treatment3.Periventricular and subcortical white matter changes of a mild degree and the signal changes within the brain stem are nonspecific. At this age they are most likely vascular related. This is stable compared to the prior exam.