Metastatic NSCLC to the brain. Status post stereotactic radiosurgery to the left frontal and left occipital regions and subsequently to right frontal and left occipital lesions.Additional clinical history from electronic medical records:L frontal and L occipital regions SRS 20 Gy x 1 on 7/8/15R frontal and L occipital regions SRS 20 Gy x 1 on 11/18/15 The ringlike contrast enhancing lesion in the left occipital lobe has increased in size, now measures up to 15 mm transaxially, compared to 5 mm previously. The contrast-enhancing rim is associated with susceptibility effect. There is also surrounding confluent T2-hyperintensity, consistent with edema.The small left frontal lesion with associated susceptibility effect is not significantly changed in size but shows more pronounced peripheral contrast enhancement, especially posteriorly, on axial imaging. However, the axial imaging on today's examination was obtained in a slightly more delayed fashion compared to on the previous examination, which may account for the apparent increase in contrast enhancement. The surrounding confluent T2-hyperintensity is unchanged to very minimally increased.The tiny right frontal lesion with associated susceptibility effect remains unchanged, without associated contrast enhancement or surrounding edema. Other similar small lesions in the deep posterior left parietal lobe and the superficial right middle frontal gyrus remain unchanged, also without associated contrast enhancement or surrounding edema.There is no acute infarct or acute intracranial hemorrhage. Tiny CSF intensity focus in the left midbrain is unchanged, and may represent a tiny chronic lacunar infarct or atypical dilated perivascular space. The left frontal developmental venous anomaly is unchanged. Major intracranial vascular flow voids are preserved. There is incidental finding of a small defect involving the anterior aspect of the falx.Orbits show findings of previous bilateral lens replacement. The mastoid air cells are clear. There is trace mucosal thickening in the ethmoid sinuses.
1.Since February 9, 2016, there has been increase in the size of the ring-enhancing lesion in the left occipital lobe with increased associated edema, which may reflect evolving post stereotactic radiosurgery change. However, progression of the metastasis can also appear similar. Continued follow-up is recommended.2.The small left frontal lesion shows apparent minimal increase in the peripheral contrast enhancement but this might be artifactual, from differences in technique as described above. The associated surrounding T2-hyperintensity is unchanged or very minimally increased.3.The other 2 right frontal and 1 left parietal lesions remain unchanged, without associated contrast enhancement or surrounding edema.