Per EPIC, history of chronic hepatitis B, HCC metastatic to lung (s/p sorafenib, currently on phase III study of cabozantinib 4/3-) presenting with encephalopathy. Evaluate for lesion, RPLE. Image quality is somewhat degraded by motion artifact. There is no evidence of acute intracranial hemorrhage, mass effect, or acute infarct. There is high T1 signal in the bilateral basal ganglia, particularly the globus pallidi, and thalami, as well as the cerebral peduncles. There are no enhancing intracranial lesions. There are scattered punctate foci of increased T2 signal within the periventricular and subcortical white matter, which are non-specific, but likely represent chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The skull and extracranial soft tissues are unremarkable. There is mild mucosal thickening of the bilateral ethmoid and sphenoid sinuses.
1. Findings compatible with chronic hepatic encephalopathy.2. No evidence of intracranial metastasis. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.