Reason: lung cancer with h/o brain mets, compare to previous, measurements please History: n/a. There is redemonstration of innumerable foci of abnormal enhancement with associated susceptibility consistent with chronic hemosiderin deposition, due to scattered intracranial metastatic disease. The dominant right frontal lobe peripherally enhancing lesion has slightly decreased in size, now measuring 2.0 x 2.0 cm in greatest axial dimensions on 12/149 x 2.4 cm CC on 1200/141, compared to previous 2.2 x 2.0 x 2.6 cm, respectively. Reference right paramedian parietal lesion measures 1.4 x 1.5 x 1.4 cm, compared to previous reported 1.6 x 1.6 x 1.6 cm.On the left a bilobed heterogeneously enhancing lesion has significantly decreased in size, now only measuring approximately 0.9 cm AP x 1.5 cm CC, compared to previous 1.3 x 1.8 cm.The left cerebellar lesion appears slightly increased in on 12/60, more linear in appearance than on prior exam where it seemed more punctate. Other small scattered cerebral lesions appear stable. No definite new foci of enhancement are appreciated.The extent of associated FLAIR hyperintensity surrounding the treated lesions has decreased in all locations. The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift. There is no diffusion abnormality. No extra-axial fluid collection is identified.Normal flow-voids are demonstrated in the major intracranial vascular structures. The midline structures and craniocervical junction are within normal limits. There is complete opacification of the right sphenoid sinus with associated diffusion restriction which can relate to pus, new since prior exam. There is a mucosal retention cyst in the left maxillary. Small T2 hyperintense cyst along left aspect of the odontoid tip is likely degenerative.
1. Redemonstration of multiple intracranial metastatic lesions with the largest in the cerebral hemispheres, overall decreased in size with diminished surrounding vasogenic edema since prior exam consistent with favorable treatment response.2. Stable pattern of scattered foci of susceptibility without corresponding enhancement which may represent chronic hemosiderin and/or mineralization related to treated metastases.3. Complete opacification of right sphenoid sinus, with associated diffusion restriction. Please correlate for acute sinusitis.