63 years Male (DOB:7/30/1952)Reason: mets lung cancer, brain mets, s/p WBRT, on immunotherapy now, pls c/w previous study and evaluate tx response. History: brain metsPROVIDER/ATTENDING NAME: BRITTANY L BEACH JYOTI D PATEL The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a T2, FLAIR and T1 hypointense lesion associated with susceptibility effect located along the right choroid fissure.There are multiple heterogeneous lesions within the brain parenchyma associated with susceptibility effect and heterogeneous signal on T2 and T1-weighted imaging. One is located in the right inferior parietal lobule measuring 8 mm in size involving cortex and underlying white matter. Another is present along the right temporal lobe superior temporal gyrus measuring 5 mm in size. Another is located in the right occipital lobe along the cuneus and measures 4 mm in size. Another one is located in the left cerebellar hemisphere measuring 4 mm in size, another is located in the left posterior temporal lobe and measures 4 mm in diameter. Several smaller lesions are only detected on susceptibility weighted imaging in particular in the left superior frontal gyrus and the left precentral gyrus just medial to the hand motor area and another in the right inferior parietal lobule. A punctate one is located in the left uncus.A focus of susceptibility effect is present within the velum interpositumThere is redemonstration of a sessile extra-axial mass adjacent to the right temporal lobe measuring 14 x 6 mm sagittal dimensions on 2/21/2014 measured 4 x 9 mm sagittal dimensions.There is a mild degree of periventricular and subcortical confluent hyperintense white matter lesions present identified on the FLAIR and T2 images.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Initial note is made of partial empty sella.
1.There are multiple hemorrhagic lesions scattered in both hemispheres of the brain as well as in the left cerebellar hemisphere. Additional lesions are identified in the right choroid fissure and the velum interpositum. These are known to represent treated metastases. No new metastatic foci are appreciated.2.There are periventricular white matter lesions present which are rather confluent and most likely treatment related.3.There is a small extra-axial mass adjacent right temporal lobe one possibility is that this represents a meningioma though metastatic disease cannot be entirely excluded. It has not changed substantially since 2/15/2016. It is slightly larger when compared to the 2/21/2014 exam.