Secondary malignant neoplasm of brain [C79.31] / Secondary malignant neoplasm of other parts of nervous system [C79.49], Reason for Study: ^Reason: NSCLC brain mets hx. History: hx brain mets. Previously seen left anterior mesial temporal lobe nodular enhancing lesions with the susceptibility artifacts are seen and appear to be stable. However, due to different imaging of adjacent technique (currently 4 mm thickness on fat saturation T1 axial scan and 2 mm thickness on 3-D T1 postcontrast acquisition; the 3-D acquisition was acquired in 1 mm thickness on prior scan), precise interval evaluation is impossible.There is no other abnormal enhancement on this scan.Encephalomalacia with ex vacuo changes of left lateral ventricle of the left parietal lobe especially inferior parietal lobule are again seen, unchanged since prior scan.Left caudate nucleus and bilateral cerebellar hemispheric tissue losses indicate prior ischemic infarct are again seen, unchanged.There is no evidence of acute ischemic or hemorrhagic lesion.The ventricles, sulci and cisterns are unremarkable. There is no edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia. The midline structures and cranial-cervical junction are normal. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.
1. Stable looking left mesial temporal lobe punctate enhancing foci since prior scan. However, the examination can be repeated without additional charge for precise evaluation.2. No new abnormal enhancing lesion on this scan.3. Unchanged postoperative changes of the left parietal lobe lesion and chronic ischemic infarctions on the left caudate and bilateral cerebellar hemispheres.4. No acute ischemic or hemorrhagic lesion.