58 years, Female, ovarian cancer, screening for metastasis for clinical trial.. There is no intraparenchymal mass or abnormal parenchymal or meningeal enhancement to suggest intracranial metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass effect, midline shift, or herniation. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic and/or posttreatment-related changes changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.There is large expansile, infiltrative enhancing lesion with predominantly low T1 and T2 signal involving majority of the clivus including the basisphenoid and basiocciput extending into the occipital condyles, right greater than left and also involving much of the right inferior lateral aspect of the occipital bone.
1. Expansile, infiltrative osseous lesion involving majority of the clivus and the right lateral occipital bone is suspicious for osseous metastasis. An alternative possibility of a benign osseous expansile lesion (such as fibrous dysplasia) is a consideration and would suggest CT to exclude this possibility or correlate with bone scan are other head imaging if available.2. No evidence of brain metastases.