Clinical question: Surveillance scan, status post as SRS. Signs and symptoms: As above. Nonenhanced brain MRI:Examination is performed as it was requested without intravenous contrast extending reduces the sensitivity of the exam for detection of small metastatic lesions.Negative diffusion weighted series.Within the limitation of noncontrast study a previously noted approximately 8 mm left parietal metastatic lesion cannot be identified with certainty. There is however slight interval increased vasogenic edema at this site compared to prior study. There is no evidence of hemorrhage or mass effect.A smaller right posterior parietal-occipital 3 mm enhancing metastatic lesion cannot be identified on this unenhanced study.Diffuse and scattered foci of FLAIR hyperintensity in the subcortical and periventricular white matter of bilateral cerebral hemispheres demonstrate no significant change since prior exam and suspected of chronic nonhemorrhagic small vessel ischemic strokes.The ventricular system, cortical sulci and the CSF spaces are unremarkable and similar to prior exam.
1.Nonenhanced brain MRI failed to demonstrate previously noted enhancing metastatic lesions. Note however should be made that the lack of intravenous contrast significantly reduces the sensitivity of the exam for detection of small metastatic lesions.2.Minimal interval increased vasogenic edema at the site of treated left parietal metastatic lesion is observed.3.Negative diffusion-weighted series and findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes without significant change since prior study.