Clinical question: Small cell lung cancer status post WBRT and 2 cycles of SC 16 D6.5. IRB 13-0726. Signs and symptoms: Small cell lung cancer. Pre and post enhanced brain MRI:Examination demonstrate a small focus of enhancement along the medial aspect of right anterior temporal lobe measuring approximately at 4.5 x 3.5 mm in transaxial dimensions. There is subtle FLAIR and T2 hyperintensity at the site as well and finding is highly suspected of a small metastatic lesion. This finding is best appreciated on axial post enhanced, axial flair and T2 series on image 11.Additionally there is a punctate focus of enhancement in the right subcortical white matter of the occipital lobe (coronal reformatted post enhanced series 1202, axial post enhanced series 1201 image 79) which could represent a vessel or a tiny metastatic lesion.None of above lesions were identified with certainty on prior exam.A focus of chronic hemorrhage and encephalomalacia in the right parietal lobe without detectable abnormal enhancement is again noted. The findings remain stable and demonstrate no abnormal enhancement. There is an overlapping craniotomy and this finding could represent post surgical change.Patchy cortical and subcortical/periventricular FLAIR hyperintensity without enhancement demonstrate interval progression since prior study and could represent posttreatment change. One of the foci of FLAIR hyperintensity in the left frontal lobe without demonstrated internal punctate focus of chronic hemorrhage however without enhancement which measured approximately 7.5 x 5.5 mm in size on prior exam has a slightly increased and measures at 7.5 x 11.5 mm. Finding is believed to represent post treatment change.
1.New 4.5 x 3.5 mm focus of enhancement in the medial aspect of the right anterior temporal lobe with subtle associated FLAIR/T2 hyperintensity is suspicious for a new metastatic lesion however less likely possibility of posttreatment change cannot be excluded. Punctate focus of enhancement in the right occipital lobe could represent a vascular structure or a punctate metastatic lesion. Please see above comments.2.Stable focus of hemorrhagic encephalomalacia in the right parietal lobe without interval change since prior exam.3.Focus of T2 hyperintensity and internal focus of minimal chronic hemorrhage without enhancement in the left frontal lobe as detailed. 4.Interval increased patchy foci of FLAIR and T2 hyperintensity in the periventricular and subcortical white matter since prior study likely representing posttreatment change. Please see above comments.