Clinical question: 48-year-old male with history of SCLC with metastases to liver, brain, now with weakness. Signs and symptoms: Evaluate intracranial process versus metastases. Pre-and post-enhanced brain MRI:Examination demonstrates very significant interval progression of metastatic disease. There are numerous varying size nonhemorrhagic and enhancing metastatic lesions in bilateral cerebral and cerebellar hemispheres as well as the pons. Thickening and enhancement of the ependymal lining the lateral ventricles are also highly suggestive for additional metastatic lesions. There is a small amount of peritumoral edema with the lesions all were without appreciable mass effect on the lateral ventricles and with maintained midline.There is a slight interval increased size of lateral ventricles however with maintained midline. Calvarium is intact.Unremarkable images through the orbits including axial fat sat post contrast series.
1.Significant interval progression of metastatic disease with numerous supratentorial and infratentorial parenchymal nonhemorrhagic enhancing metastatic lesions. Diffuse metastatic lesions involving the ependymal lining of the lateral ventricles.2.There is no significant mass effect or midline shift.3.Unremarkable calvarium and orbits.