58 y/o with newly diagnosed NSCLC please obtain staging brain MRI. The examination is limited by motion artifact. There is a large area of encephalomalacia involving the right temporal, parietal, occipital and posterior frontal lobes. Punctate foci of possible diffusion restriction are seen in the left middle frontal gyrus and post central gyrus (series 4, image 27-29). Numerous patchy and focal areas of T2/FLAIR hyperintensity are demonstrated in the periventricular and subcortical white matter as well as within the brainstem, likely related to chronic small vessel ischemic disease. There is confluent T2 hyperintensity likely representing gliosis surrounding the large area of encephalomalacia in the right cerebral hemisphere. No abnormally enhancing lesion parenchymal lesions are identified. There is no acute intracranial hemorrhage. No midline shift is appreciated.
1. A few punctate foci of possible subacute small vessel ischemia are demonstrated in the left middle frontal and post central gyrus.2. Large area of encephalomalacia involving the right posterior cerebral and middle cerebral artery territory circulation likely indicating prior large vessel infarction.3. No evidence for parenchymal metastatic disease.