Three intracranial lesions are demonstrated all surrounded by vasogenic oedema, and all demonstrating signal loss and intrinsic high T1 signal consistent with haemorrhagic change. The left frontal lesion exerts a significant localised mass effect, with 8 mm of midline shift.
Conclusion: Haemorrhagic metastatic disease; primaries to consider are melanoma, choriocarcinoma, thyroid, renal cell carcinoma as well as breast and lung cancer.
On CT (not shown) I note the presence of a large mediastinal mass without obvious breast, thyroid, renal or pelvic masses. As such melanoma is favoured.