68 years, Male, anaplastic thyroid cancer. Brain lesions or PET scan. There are at least 8 foci of abnormal enhancement scattered within the brain parenchyma consistent with intracranial metastases. Punctate lesions are evident in the left posterior frontal lobe, right parietal lobe, bilateral temporal lobes, right occipital lobe, as well as in the right cerebellum. A relatively larger left temporal enhancing lesion abutting the dura measures up to 18 x 14 mm. The right cerebellar lesion measures up to 7 mm. Some of these lesions demonstrate punctate susceptibility effect indicating small hemorrhage, such as a right cerebellar lesion. There is loss of sulcal CSF suppression on the FLAIR sequence in the left occipital lobe with corresponding susceptibility effect most compatible with a small subarachnoid hemorrhage. There are also punctate parenchymal foci of susceptibility in the left occipital lobe without associated enhancement compatible with nonspecific microhemorrhage. There is a wedge-shaped focus of diffusion restriction involving the left posterior cerebellar hemisphere with associated T2/FLAIR hyperintensity and no significant enhancement which likely represents a subacute left cerebellar infarct. Additional foci of diffusion hyperintensity correspond to the small foci of hemorrhage above. A punctate focus of diffusion hyperintensity in the left postcentral gyrus may be artifactual.There are scattered foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. There is mild edema associated with some of the lesions. No significant intracranial mass effect, midline shift, or herniation is evident. No hydrocephalus. Minimal scattered paranasal sinus opacification. Calvarium and extracranial soft tissues are grossly unremarkable.
1. Multiple foci of abnormal parenchymal enhancement in the brain are compatible with intracranial metastases. The multiple intraparenchymal lesions are subcentimeter. A relatively larger left temporal lesion measures up to 18 x 14 mm and abuts the dura, and favored to represent a dural based metastasis (a meningioma as an alternative explanation for the solitary dural based lesion seems less likely). There is mild associated edema without significant intracranial mass effect, midline shift, or herniation.2. Suspected acute to subacute small infarct in the left cerebellar hemisphere.3. Likely small left occipital subarachnoid hemorrhage.Dr. Ali discussed findings with Dr. Sarne on 8/27/2016 at 925 hrs.