Metastatic non-small cell lung cancer with brain metastases No abnormal parenchymal or meningeal enhancement is appreciated. No intracranial mass or mass effect. Again seen is extensive confluent T2/FLAIR hyperintensity in the bilateral frontoparietal and to a lesser degree temporal and occipital white matter most compatible with treatment related encephalopathy. No restricted diffusion to suggest acute ischemia. The ventricles are within normal limits in size and configuration. There are multiple scattered foci of susceptibility effect including the right temporal lobe, as well as the bilateral cerebellar hemispheres similar to prior.Major flow-voids are preserved. There is prominent flow-void involving the right supraclinoid internal carotid artery consistent with aneurysm and similar to prior.There is moderate opacification of the right sphenoid sinus including the lateral recess, new since prior. Left maxillary mucous retention cyst again seen. Minimal fluid within the bilateral mastoid air cells again seen. There is a 1 cm enhancing lesion involving the left frontal calvarium at the vertex and the right parietal calvarium, axial post gad T1 fat-sat series 11 images 5 and 8, not seen previously. No large destructive osseous lesions.
1. No evidence of intraparenchymal or leptomeningeal metastatic disease.2. There are two, approximately 1 cm in size, enhancing lesions in the left frontal and right parietal calvarium which are not seen on prior studies (axial postgad T1 fat-sat series 11, images 5 and 8). These are nonspecific but possibility of osseous metastatic disease is not excluded. Consider close follow-up examination.3. Unchanged extensive supratentorial white matter abnormality most compatible with treatment-related leukoencephalopathy.4. Unchanged scattered punctate foci of chronic microhemorrhages which are nonspecific and can be seen with entities such as chronic hypertension as well as sequela of radiation treatment. 5. Right supraclinoid internal carotid artery aneurysm again seen and grossly similar in size to prior but can be better evaluated with dedicated MR or CT angiogram.6. New right sphenoid sinus opacification with fluid-level which can be seen with acute sinus disease in the appropriate clinical setting.