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Date : 00.00.00Name of the Patient : Abc Xyzben lmn / F / 63 yrs.Referred by : Dr. Abc Xyzshar.Examination : M.R.I. of the Brain.
CLINICAL PROFILE : Known C/O adenocarcinoma of lung with metastasis to the brain. Gamma knife radiosurgery for the brain metastasis was performed in August 0000. For follow-up.EXAMINATION :
M.R.I. of the brain was performed using the following parameters:
5 mm thick T1 Weighted, Proton and T2 Weighted axial images.5 mm thick FLAIR coronal images.
After administration of contrast, the following parameters were used :5 mm thick T1 Weighted axial and coronal images with magnetization transfer.5 mm thick T1 Weighted sagittal images.OBSERVATION :There is seen an approximately 4.2 x 3.5 x 3.2 cms sized well marginated, predominantly hyperintense lesion on the proton, T2 Weighted and FLAIR images in the left parieto-occipital-parafalcine region. This lesion appears hypointense on the T1 Weighted images. Faint hyperintense signal is noted within this lesion on the T1 Weighted images (? paramagnetic substances, ?? haemorrhage). This lesion enhances

patchily after contrast administration. There is perilesional edema with effacement of the sulcal spaces in the left parieto-occipital region and mild compression and anterior displacement of the occipital horn and atrium of the left lateral ventricle. Edema is also seen to encroach into the splenium of the corpus callosum on the left side and the posterior limb of the internal capsule.
A smaller, ring enhancing lesion is noted in the right parieto-occipital region, measuring approximately 1.2 cms in maximum transverse dimension. Mild perilesional edema is also noted around this lesion. Another very small, enhancing focus is noted in the right posterior temporo-occipital region. Small bright foci on FLAIR images are noted in the frontal white matter bilaterally. The right lateral, third and the fourth ventricles are normal. The basal cisternal spaces are unremarkable. There is no shift of the midline structures. No obvious vascular anomaly is identified on this study.There is no other focal area of abnormal enhancement in the brain parenchyma or the meninges.IMPRESSION :The MRI features suggest multiple metastasis in the brain parenchyma as described above. As compared to the previous MRI (study no:00002) dated 00.00.00, there is increase in the size of the lesions, especially in the left parieto-occipital parafalcine region and the surrounding edema.

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