Findings:
Relatively unchanged appearance of the punctiform cortical enhancement in the right frontal lobe with minimal surrounding oedema. No evidence of any new enhancing lesions.
Advanced small vessel ischaemic disease including multiple lacunes in bilateral basal ganglia, thalami and pons.
Numerous cortical/lobar, deep basal ganglia and brainstem and cerebellar microbleeds. No diffusion restriction.
Involutional changes are seen in the brain parenchyma in the form of prominent cortical sulci and widened ventricles. There is no midline shift.
The intracranial circulation is unremarkable.
The pituitary gland is normal.
Mucosal thickening is seen in the paranasal sinuses bilaterally. The orbits and the mastoid air cells are clear.
No bony abnormality is seen.
Conclusion:
Stable appearance of the known, small metastases in the right frontal lobe. No new metastases.
Known advanced small vessel ischaemic disease and mixed lobar and deep cerebral microbleeds.