69-year-old male with a history of metastatic small cell lung cancer s/p chemoradiation and surgery (off chemo since June 2015) presents with an abnormal PET and weakness, evaluate for brain metastases. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are and sulci are prominent compatible with volume loss, which is advanced for age. Extensive patchy areas of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter which are grossly similar to the prior examination. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.There is trace mucosal thickening involving the paranasal sinuses and mild opacification of the left mastoid air cells. Note is made of a right lens implant. Subtle postsurgical changes are noted in the left parietal scalp at the vertex. No discrete underlying lesion is evident. Adjacent calvarium is intact.
1. No evidence of intracranial metastatic disease. No evidence of acute infarct or intracranial mass effect. 2. No significant change in extensive signal abnormality involving the supratentorial white matter which may reflect posttreatment related leukoencephalopathy and/or chronic small vessel ischemic disease.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.