Extensive stage SCLC, being considered for preventative cranial irradiation. There is a new ovoid area of restricted diffusion in the left middle frontal gyrus that measures approximately up to 15 mm, with surrounding vasogenic edema. The lesion contains a focus of restricted diffusion in the right middle frontal gyrus that measures up to approximately 5 mm, which may represent hemorrhage or calcification, for example. There is no midline shift or herniation. There is mild diffuse periventricular white matter T2 hyperintensity, which may represent chronic small vessel ischemic disease. There is no evidence of acute territorial infarct. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The skull and orbits are unremarkable. There is moderate mucosal thickening in the right maxillary sinus. There is an unchanged left parietal scalp lipoma.
New lesions in the bilateral frontal lobes likely represent metastatic disease with associated vasogenic edema, but no midline shift. However, the assessment is somewhat limited by the lack of intravenous contrast.Discussed with Dr. Malik at 8:20 AM on 1/7/15.