50 years, Female, metastatic lung cancer. ALK+, failed Crizotinib. Baseline study for Alectinib trial. No intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. No midline shift or herniation. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Lipoma is incidentally noted involving the left frontal scalp. Bone marrow signal and extracranial soft tissues are otherwise unremarkable.
1. No evidence of intracranial metastatic disease.2. Scattered foci of T2/FLAIR hyperintensity in the supratentorial white matter are nonspecific but compatible with mild chronic small vessel ischemic and/or posttreatment-related changes.