Clinical question: 59-year-old male with an NSCLC with adrenal, liver, pelvis metastases, need MRI of brain for complete workup. Signs and symptoms: NSCLC. Pre and post enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates a tiny focus of FLAIR hyperintensity in the subcortical white matter of left frontal lobe, small focus of FLAIR hyperintensity in the genuine of corpus callosum and a punctate focus of similar signal change in the white matter of left posterior temporal lobe, punctate foci in the left cerebellum and pons. Findings are nonspecific, nonhemorrhagic, nonenhancing. Considering patient's stated age differentials of mild chronic small vessel ischemic strokes or demyelinating disease should be considered. The overall anatomical morphology of the brain as well as its signal intensity remains otherwise within normal on all MRI sequences and without detectable abnormal enhancement to suggest metastatic disease.Calvarium and soft tissues of the scalp demonstrate normal signal intensity and without abnormal enhancement.Images through the orbits demonstrate a chronic blowout fracture of the left lamina papyracea and unremarkable otherwise.On paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal patterns.
1.No evidence of metastatic disease.2.Negative diffusion-weighted series and findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.