Reason: stage IVb lung adenocarcinoma EGFR exon 21 L858R mutation, on Tarceva, evaluate response. History: h/o small brain mets There are subcentimeter foci of subtle enhancement in the right superior frontal gyrus (series 11 image 26), right posterior cingulate sulcus (series 11 image 23), and right sylvian fissure (series 12 image 9). These lesions have mild intrinsic T1 hyperintensity and questionable susceptibility artifact. There is no associated edema of the adjacent brain parenchyma, which may suggest that these lesions are leptomeningeal in location. Nonspecific scattered punctate FLAIR hyperattenuation is noted in the subcortical and periventricular white matter.There is a round, intrinsically T1 hyperintense, 7 mm lesion in the anterior sella situated above the pituitary gland. The lesion does not enhance beyond its intrinsic T1 hyperintensity. The native pituitary gland is evident inferior to this lesion.No abnormal diffusion restriction. No gross intracranial hemorrhage is identified. No evidence of intracranial mass, mass-effect, or midline shift. No extra-axial fluid collections. The ventricles, sulci, and cisterns are normal in size without evidence of hydrocephalus. Gray-white matter differentiation is preserved. Nonspecific mucosal thickening of the left ethmoid air cells. Otherwise paranasal sinuses and mastoid air cells are clear. The imaged orbits are intact. The osseous structures are unremarkable.
There are subcentimeter foci of subtle enhancement in the right superior frontal gyrus, right posterior cingulate sulcus, and right sylvian fissure. These lesions have mild intrinsic T1 hyperintensity and questionable susceptibility artifact. There is no associated edema of the adjacent brain parenchyma. Findings are suspicious for the presence of intracranial metastases, potentially leptomeningeal in nature.Incidental note is made of an intrinsically T1 hyperintense lesion within the anterior sella situated above the native pituitary gland. This could represent a Rathke cleft cyst, or perhaps an adenoma which has undergone proteinaceous or hemorrhagic degeneration.