Lung squamous cell carcinomas brain and spinal metastasis. Altered mental status. The study is limited by patient motion.The multiple cortical and subcortical foci of contrast enhancement in both cerebral hemispheres show no significant overall change since the previous examination from March 2016. For example, cortical enhancement along the right central sulcus, which also shows diffusion restriction, is mildly improved with improved associated edema. Most of the other lesions are similar to prior. A few appear to be very slightly more prominent than on the prior examination, including one in the right pars opercularis, which shows slightly increased enhancement and slightly increased edema. Many of the lesions show associated susceptibility effect reflecting the presence of microscopic blood products or mineralization. There is no definite new focus of contrast enhancement. There is no significant mass-effect, midline shift or brain herniation. While the cortical contrast enhancement may involve the adjacent leptomeninges, there is no diffuse pachymeningeal or leptomeningeal contrast enhancement. No enhancement of the cranial nerves is seen.Bifrontal encephalomalacia with surrounding T2 hyperintensity, left side more so than right, is unchanged compared to the April 2016 examination. Mild ex vacuo enlargement of the frontal horns of the lateral ventricles is also unchanged. This may reflect posttreatment change. The major intracranial vascular flow voids are preserved.There is minimal fluid signal intensity in the mastoid air cells, which is unchanged. The orbits are grossly unremarkable. There is no destructive skull lesion.
1.The examination is at least moderately limited by patient motion.2.Compared to March 2016 examination, there has been no significant overall change involving the numerous small cortical/subcortical enhancing lesions. Mild interval changes as described above, with some lesions appearing slightly smaller and others slightly larger, could be accounted for by differences in the technique between the two examinations.