Lung cancer with history of brain metastases. There is a newly apparent punctate focus of restricted diffusion in the right parietal lobe. There are multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres. There is unchanged diffuse cerebral white matter T2 hyperintensity bilaterally, predominantly in a periventricular distribution. There is no abnormal intracranial enhancement. There is a newly apparent punctate focus of restricted diffusion in the right parietal lobe. There is diffuse cerebral volume loss. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are unremarkable. There is minimal mucosal thickening in the maxillary sinuses.
1. A newly apparent punctate focus of restricted diffusion in the right parietal lobe likely represents a recent infarct and less likely an atypical metastasis.2. Multiple unchanged punctate foci of susceptibility effect in the bilateral cerebral hemispheres appear to correspond to treated metastases.3. Unchanged diffuse cerebral white matter T2 hyperintensity bilaterally is nonspecific, and may represent treatment effects and/or chronic small vessel ischemia.