71 years, Male, newly diagnosed metastatic non-small cell lung cancer to the brain. Limited sequences of the brain are obtained per radiation treatment planning protocol. There are at least 10 enhancing lesions scattered in the bilateral cerebral hemispheres, cerebellum, and brainstem. A relatively large necrotic left parietal mass measures 3.3 x 2.7 x 2.3 cm, with a component medially which appears to extend into the posterior falx. There is an adjacent small left parietal lesion superior and laterally which extends to the dural surface. The largest right cerebral hemisphere lesion is in the right temporal lobe and measures 15 x 16 x 11 mm. Noted are small lesions including the right thalamus as well as involving the right superior tectal plate which narrows the cerebral aqueduct, but remains otherwise patent. Ventricles remain normal in size; no hydrocephalus. Small foci of susceptibility effect are noted associated with some of the lesions compatible with minimal chronic blood products. Cerebellar lesions are relatively small although two lesions on the right appear to extend in a somewhat linear fashion along the cerebellar surface with configuration suspicious for leptomeningeal disease.There is moderate degree of vasogenic edema associated with the left parietal lesion as well as mild associated mass effect on the left lateral ventricle. There is however no significant midline shift or evidence of herniation.Partially imaged cervical spine demonstrates moderate to severe spinal canal stenosis at the C3-C4 and C4-C5 levels related to disc osteophyte complexes, and ligamentum flavum thickening. There also appears to be spinal canal stenosis more inferiorly at C5-C6 and below.
1. Diffuse intracranial metastatic disease with greater than 10 lesions throughout the brain as described above. Notably, a relatively large left parietal mass is associated with moderate degree of edema; a small right midbrain tectal lesion narrows the cerebral aqueduct without evidence of hydrocephalus; there is suspicion of dural and leptomeningeal involvement as described above, and small foci of hemorrhage associated with the lesions.2. No significant midline shift or herniation.3. Moderate to severe spinal canal stenosis at the C3-C4 and C4-C5 levels on a degenerative basis.