58 years, Female, non-small cell lung cancer. Evaluate for restaging. There is no restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. There is increased size and number of intraparenchymal metastases scattered throughout the brain parenchyma. The largest lesion is located within the left cerebellum and measures 0.9 x 0.7 cm, previously 0.6 x 0.6 cm. There are sequela of previously treated metastases identified on MRI June 6, 2014, now visible as punctate T1 iso- to subtly hypointense lesions.There is new gyriform enhancement along left greater than right temporal lobes (series 1101, image 13; series 1101, image 72), and along the temporal horn of the right lateral ventricle (series 9, image 13). Additional foci of enhancement are identified within the right hippocampus (series 1101, image 89). There are a few punctate foci of susceptibility, with no associated lesion, probably microhemorrhages. There is new curvilinear susceptibility along left posterior parietal sulci (series 7, image 43), probably hemosiderin deposition consistent with superficial siderosis.There is no midline shift or herniation. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but probably secondary to chronic small vessel ischemic changes. Major flow-voids are preservedSella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits.
1.Increased size and number of multiple brain metastases. However, comparison is limited due to absence of intravenous contrast on the prior study. In comparison to earlier contrast-enhanced study June 6, 2014, there is decreased size of previously identified enhancing metastases, probably secondary to treatment-related change, but multiple new metastases and increased size of dominant cerebellar metastasis.2.New gyriform enhancement along the bilateral temporal lobes and temporal horn of right lateral ventricle, most likely due to metastatic disease.3.New curvilinear area of susceptibility along the left posterior parietal sulci, consistent with interval microhemorrhage possibly from metastases or prior trauma.