Clinical question: History of lung cancer, evaluate for metastases, compared to prior. Signs and symptoms: None. Pre- and post enhanced brain MRI:No diffusion-weighted abnormalities.Post enhanced images are degraded due to artifact which precludes precise assessment for detection of very small lesions. Within this limitation however there is no convincing evidence of any residual parenchymal or leptomeningeal enhancement to suggest metastatic disease. This is an improvement compared to prior study.Patchy foci of FLAIR hyperintensity in the periventricular and subcortical white matter of cerebral hemispheres remain grossly similar to prior exam and suggestive of chronic small vessel ischemic strokes as well as overlapping postradiation changes. Mildly dilated supratentorial ventricular system with maintained midline remain similar to prior exams.No detectable abnormal enhancement of calvarium.Unremarkable images through the orbits including axial fat sat post enhanced series.All paranasal sinuses demonstrate normal pneumatization signal patterns.
1.No detectable residual metastatic disease. Note however should be made that post enhanced images are degraded due to artifacts which preclude detection of tiny metastatic lesions.2.Periventricular and subcortical FLAIR hyperintensity grossly similar to prior exam and likely representing a combination of chronic small vessel ischemic strokes and post treatment/radiation changes.3.Unremarkable calvarium, paranasal sinuses and orbits.