58 years, Male, evaluate for progression of metastatic disease. Malignant neoplasm of right lung. There is no intracranial mass or abnormal parenchymal or meningeal enhancement. There is extensive T2/FLAIR hyperintensity involving the bilateral periventricular and subcortical white matter which is nonspecific but compatible with posttreatment-related and/or advanced chronic small vessel ischemic changes; this finding is similar to prior. There is moderate degree of global parenchymal volume loss. There are few scattered foci of susceptibility consistent with chronic microhemorrhages primarily in the left parietal lobe and also one in the right inferior cerebellar vermis; some of these are present on recent MRI from 8/23/2016 and not seen on earlier studies. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved.There is a right maxillary mucus retention cyst. No gross destructive calvarial lesions are appreciated.
1. No evidence of progression of intracranial metastatic disease.2. No evidence of recurrence of a previously treated right frontal lesion.3. Extensive white matter signal abnormality is similar to prior and may represent treatment effect and/or chronic small vessel ischemic disease.4. Few punctate foci of susceptibility effect are nonspecific but compatible with chronic microhemorrhages or mineralization. These are primarily in the left parietal lobe and are new or more prominent than multiple prior studies. There is no associated enhancement but suggest attention on follow-up.