Clinical question: Evaluate known metastatic lesions. Signs and symptoms: Headache and nausea/vomiting. Pre-and post-enhanced brain MRI:Examination demonstrate multiple nonhemorrhagic supratentorial and infratentorial metastatic lesions as was seen on prior exam.A large necrotic enhancing metastatic focus with extensive surrounding vasogenic edema is present in the cingulate gyrus of the right mid frontal lobe. It measures 19 x 24-mm thin cuts axial post enhanced images. There is resultant mass effect on the corpus callosum on the adjacent cortical sulci.Second largest supratentorial metastatic enhancing necrotic tumor is in the anterior tip of the right temporal lobe and measuring 21 times 19-mm in size. This finding also demonstrate extensive surrounding vasogenic edema length result of regional mass effect.Third largest supratentorial metastatic lesion is in the right basal ganglia measuring at 15 times 11-mm in transaxial dimension which also demonstrates central necrosis and surrounding vasogenic edema. Multiple additional small scattered metastatic lesions involving the cerebral hemispheres and including lesions at the level of ependymal lining of the ventricle.Mass effect on the right lateral ventricle the resultant significant collapse of the ventricle and deviation of midline to the left of approximately 7.5 mm at the level of the septum pellucidum is noted. The left lateral ventricle remains normal in size.Images through posterior fossa demonstrates a single tiny enhancing metastatic lesion in the inferior right cerebellum in paramedian location measuring approximately 6 mm in transaxial dimensions. No significant mass effect is associated with this finding.There is no evidence of leptomeningeal enhancement and no detectable calvarial abnormal enhancement.Unremarkable images through the orbits and including axial fat sat post enhanced series.The signal intensity of paranasal sinuses and all mastoid air cells and middle ear cavities are within normal.
1.Multiple varying size necrotic, rim enhancing metastatic lesions in bilateral cerebral hemispheres with resultant approximately 7.5 mm deviation of midline to the left as detailed/measured above. Tiny right inferior cerebellar metastatic focus without appreciable mass effect.2.No detectable abnormal enhancement of the leptomeninges, calvarium, soft tissues of the scalp over the orbits.