NSCLC with brain metastases status post SRS. There has been interval increase in size of the posterior left fusiform gyrus lesion, which measures up to 8 mm, previously 6 mm. The surrounding edema has increased in extent as well. In addition, there has been interval increase in size of an enhancing lesion in the left posterior cingulate sulcus, measuring up to 8 mm, previously 4 mm. Furthermore, an enhancing lesion along the anterior aspect of the right precentral gyrus measures up to 4 mm, previously 1 mm, and an enhancing lesion in the right middle frontal gyrus measures up to 5 mm, previously 3 mm. There is also a new subependymal enhancing lesion along the lateral aspect of the left lateral ventricle, measuring up to 5 mm. On the other hand, the lesion in the left flocculus has decreased in size now measures up to 8 mm, previously 11 mm, and a lesion in the right anterior frontal lobe now measures 2 mm, previously 4 mm. In addition, a previously demonstrated lesion in the right superior frontal gyrus is no longer discernible. There is no evidence of acute infarct. There are subcentimeter foci of encephalomalacia in the bilateral thalami and adjacent to the left frontal horn of the lateral ventricle. There is also an unchanged background of nonspecific cerebral white matter T2 hyperintensity. The ventricles and basal cisterns are unchanged in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues appear unchanged, including an enhancing nodule in the right parietal scalp, which measures up to 3 mm in width. There are bilateral mastoid air cell effusions.
1. Apparent mixed response of the intracranial metastases.2. Unchanged nonspecific punctate right parietal scalp lesion.3. Chronic lacunar infarcts and probable chronic small vessel ischemic disease.