Clinical question: Metastatic lung cancer, brain metastases, status post RT, ALK+, status post 4 cycles of Alectinib. Please compare with prior exam. Signs and symptoms: Pain metastases. Pre- and post enhanced brain MRI:Examination demonstrates interval improvement in metastatic disease since prior study.Few smaller lesions seen on prior exam are no longer identified. Several remaining metastatic lesions are measured and all appear smaller since prior exam. As for example a right posterior cerebellar metastatic lesion measuring at 7 mm compared to prior study measurement of 11.A right anterior temporal metastatic lesion measuring at 3.8 mm compared to prior study measurement of 7.6 mm.A right caudate head metastatic lesion measuring at 7 mm compared to prior study measurement of 8.A left basal ganglia metastatic lesion measuring at 6.5 mm compared to prior study measurement of 8.2 mm.A left frontal periventricular white matter metastatic lesion measuring at 7 x 7.5 mm compared to prior study measurement of 10 x 8.2 mm.Similar to prior exam nearly all metastatic lesions demonstrate internal hemorrhage is. Minimal surrounding vasogenic edema of several metastatic lesions are present however with interval improvement since prior exam. There is no evidence of any appreciable mass effect or midline shift.There is no detectable calvarial metastatic lesions.Unremarkable images through the orbits.
1.Interval improvement of intracranial diffuse metastatic lesions since prior study.2.Interval near-complete resolution of few of the smaller previously seen metastatic lesions.3.Intervertebral decreased size of several remaining metastatic lesions as detailed/measured above.4.No evidence of any significant mass effect or midline shift.5.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.