Clinical question: Newly diagnosed small cell lung cancer. Initial CNS staging. Signs and symptoms: No CNS symptoms. Pre-and post-enhanced brain MRI:Examination demonstrate multiple small nonhemorrhagic enhancing metastatic lesions in the supra-and infratentorial brain parenchyma.There is a left posterior frontal metastatic lesion measuring at approximately 11 mm sized with minimal associated surrounding edema and no mass effect (post-enhanced SPGR series 13 image 147).There is a small 7.9-mm metastatic lesion in the left anterior temporal lobe on series 13 image 66.There is a left posterior temporal -- occipital metastatic lesion measuring approximately 6 mm on series 13 image 51.There is a right cerebellar metastatic lesion measuring at 4.9-mm on series 13 image 36.There is a 7.7-mm metastatic lesion in the inferior left cerebellum on series 13 image 26.There are a few nonspecific small foci of flair hyperintensity in the subcortical and periventricular white matter which could represent mild chronic small vessel ischemic strokes.Ventricular system and the CSF spaces are within normal and with maintained midline.Unremarkable images through the orbits.Mild diffuse chronic sinusitis more severe in the right chamber of the sphenoid and bilateral maxillary sinuses (left greater than right).No convincing evidence of calvarial metastatic lesions.
1.Multiple small supra-and infratentorial parenchymal metastatic lesions as detailed/measured above. The lesions demonstrate minimal surrounding edema and no mass effect. No convincing evidence of osseous metastatic lesions.2.Negative diffusion weighted images and findings suggestive of very minimal chronic small vessel ischemic strokes.3.Mild diffuse chronic sinusitis more severe in the right chamber of the sphenoid sinus and the maxillary sinuses (left greater than right).