Small cell lung cancer, refractory nausea and vomiting. Evaluate for metastasis. No evidence of intracranial metastatic disease. No abnormal parenchymal or meningeal enhancement. No intracranial mass or mass effect. No evidence of parenchymal edema. No midline shift or herniation. Again seen is extensive patchy T2 hyperintensity within the periventricular and subcortical white matter as well as the pons which is nonspecific but consistent with chronic small vessel ischemic disease. Ventricles and sulci are slightly prominent consistent with mild volume loss inappropriate for patient's advanced age. No evidence of acute ischemia or hemorrhage. No extra-axial collections. Multiple subcentimeter enhancing lesions are seen scattered in the calvarium which may represent osseous metastases. At least most of these appear to be unchanged since prior study but difficult to compare due to their small size. No large lesions or evidence of epidural extension of tumor.
1. No evidence of metastatic disease to the brain. No intracranial mas or mass effect.2. Multiple small enhancing foci are noted in the calvarium which are suspicious for osseous metastatic disease. No large destructive lesions. Bone scan may be considered for further assessment of extent of osseous metastatic disease if clinically indicated.3. Extensive chronic small vessel ischemic disease similar to prior.