Clinical question: Patient with metastatic lung cancer with prior brain metastases status post radiation. Signs and symptoms: As above. Pre and post enhanced brain MRI:No evidence of restricted diffusion.Examination redemonstrate a small enhancing metastatic focus in the left anterior temporal lobe measuring approximately 4.5 mm compared to prior study measurement of 6 mm. There is no convincing evidence of any additional enhancing metastases lesions in the left anterior temporal lobe as was reported on prior study.There are no additional foci of parenchymal or leptomeningeal enhancement to suggest additional metastatic lesions. There are however multiple small foci of susceptibility signal changes without enhancement in bilateral cerebral and bilateral cerebellum without change since prior exam which could represent regions of chronic hemorrhage, abnormal, treated metastatic lesions or post treatment related findings.Ventricular system, CSF spaces and cortical sulci remain within normal and without change since prior exam.Calvarium is again demonstrate multiple foci of signal changes and enhancement without convincing evidence of interval change. The enhancement of the left frontal calvarial metastatic lesion is less conspicuous on current study which may be as a result of interval treatment. There is no detectable epidural spread of tumor from calvarial metastatic lesions.Approximately 5 mm left retro-orbital enhancing presumably metastatic lesion demonstrates no significant change.
1.No acute intracranial process.2.4.5 mm left anterior temporal metastatic lesion compared to prior study measurement of 6 mm. No convincing evidence of additional parenchymal or leptomeningeal enhancing metastatic lesions.3.Stable approximately 5 mm left retro-orbital enhancing metastatic focus.4.Multiple calvarial metastatic lesions without change in the size however the left frontal calvarial metastases demonstrate less conspicuous pattern of enhancement.