Clinical question: Lung cancer, prior brain metastases and RT, restaging. Signs and symptoms: Brain metastases, restaging. Pre and postcontrast enhanced brain MRI:Negative diffusion weighted images.New since prior exam is a focus of enhancement along the superior aspect of right cerebellum measuring 7 x 5 mm in transaxial dimensions and consistent with a metastatic lesion since prior scan exam.Additional tiny new focus of enhancement in the left basal ganglia measuring approximately 4 mm in transaxial dimensions as well suggestive of a new metastatic lesion.A second tiny focus of enhancement in the left basal ganglia measuring approximately at 1.7 mm size is noted.There is a punctate new focus of enhancement in the cortex of the right anterior parietal also consistent with new metastatic lesion (axial post enhanced series 1/1/2001 image 28).A tiny focus of hemorrhagic and enhancement in the right posterior frontal cortex is less conspicuous compared to prior exam and represent a small remaining metastatic focus. Few of the new and old lesions demonstrate subtle surrounding FLAIR hyperintensity/edema however none with evidence of any mass effect.Ventricular systems remain within normal size and with maintained midline and with patent cortical sulci and basal cisterns.There is no detectable abnormal enhancement of the calvarium.Unremarkable images through the orbits and including axial fat sat post enhanced series..
1.Multiple small new metastatic lesions since prior exam both in supra and infratentorial brain parenchyma as detailed/measured above.2.No significant associated mass effect with the findings and with maintained midline.3.Unremarkable calvarium and orbits without abnormal enhancement.