Brain Metastases (MR).

PROTOCOL:
T2W – Sagittal & axial scans
T1W – Axial scans
FLAIR – Coronal scans
DW & T2FFE (Gradient) – Axial scans
3D TOF MR angiography of the circle of Willis vessels and MIP reconstruction.

FINDINGS:

-A space occupying lesion is noted in the left occipital lobe measuring about 42 x 31 mm in diameters. It is characterized by hypo intensity with multiple areas of hyper intensity on T1; iso intensity on Flair images and T2 with surrounding peri focal edema while on gradient; it shows also multiple areas of blooming effect.
-After contrast injection; the lesion appears to be of heterogeneous faintly abnormal enhancement.
-It causes shift of the mid line structures by about 3.6 mm with mild compression of the ipsilateral lateral ventricle.
-Another small focal lesion is noted in the right parietal region above the level of lateral ventricle with significant contrast enhancement.
-Till the time of this study; no evidence of conization.

-The rest of the brain Parenchyma shows normal grey white matter differentiation and signal intensities.  No focal mass lesion is seen.
-Basal cisterns, cortical sulci and gyri are normal in appearance.
-Corpus callosum shows normal MR morphology.
-Brain stem and cerebellum show normal signal intensities.
-Fourth ventricle is normal in size and is midline in position.
-MR angiography reveals normal course, caliber and outlines of vessels of bilateral CA, ACA, MCA, PCA and their peripheral branches. Vertebro basilar trunk is also normal in appearance.

OPINION:

• As regards the given history for malignancy; picture is suggestive of metastatic hemorrhagic brain lesion.
• Another smaller lesion is noted in the right parietal region above the level of lateral ventricles.