Female, 65 years old, history of small cell lung cancer with brain metastases status post radiation treatment. Most of the innumerable large enhancing lesions seen on the pretreatment examination remain significantly reduced in size or even undetectable with minimal if any enhancement above and beyond intrinsic T1 hyperintensity. Most of these prior lesions are hemosiderin stained. A formerly large extra-axial lesion along the right frontal lobe with a hemorrhagic component has been reduced to a small hemosiderin stained cystic space which has further decreased in size since the prior examination.However, a few enhancing lesions are now evident which were not seen on the prior examination or on the pretreatment exam. For example, there is a 4 mm lesion along the right superior frontal gyrus, a 6 mm lesion along the orbital gyrus of the right inferior frontal lobe, a 4 mm lesion within the left frontal operculum and a 5 mm lesion along the left precuneus. None of these lesions is associated with significant parenchymal edema or mass effect.Further interval progression of periventricular T2 hyperintensity is seen, particularly adjacent to the right frontal horn. The ventricles are stable in size relative to the prior examination but remain slightly larger than that seen on the pretreatment exam.
1.Numerous formerly large enhancing lesions seen on the pretreatment examination remain under excellent control showing stable or reduced size and minimal if any enhancement, mass effect and edema.2.Since the prior examination, however, at least 4 subcentimeter enhancing lesions have developed which were not evident on the immediate prior or on the pretreatment examinations. These are concerning for progressive metastatic disease.