Female, 70 years old, with small cell lung cancer, status post 4 cycles of carbo etoposide. A 4 x 3 mm cortically based focus of enhancement within the left pre-central gyrus is new from prior. This lesion induces mild local edema but no significant mass effect. Two additional 2-mm foci of cortically based enhancement on either side of the left post-central sulcus are also new from prior. These two lesions, however, induce no detectable edema. No additional enhancing lesions are seen. Scattered small foci of white matter T2 signal abnormality are similar to prior. No significant mass effect is detected. No evidence of intracranial hemorrhage is seen. The ventricles are normal in size and morphology.Conventional aortic branching is seen. The origins of the great vessels are patent. The right internal carotid artery is completely occluded at the bifurcation. No flow related signal is seen until the communicating segment where reconstitution occurs. The left ICA is severely narrowed at the bifurcation (at least 70% by NASCET criteria) but shows normal caliber beyond the bifurcation. The cervical vertebral arteries are prominent bilaterally, relatively symmetric in caliber, and free of significant stenosis. These findings are unchanged from prior.A 5 x 3 mm aneurysm arises between the origins of the right P1 segment and SCA. An additional 4 x 2 mm aneurysm arises from the left MCA bifurcation. Both lesions are unchanged. There may be a 2 to 3 mm aneurysm arising from the ACOM artery, but this is not entirely well seen due to technical issues. As above, the right ICA shows no evidence of flow until the communicating segment where reconstitution occurs. From this point, the ICA and subsequent MCA branches show relatively normal caliber. The remainder of the intracranial circulation is free of significant stenosis.
1.A 4-mm cortically based enhancing focus within the left pre-central gyrus, causing mild local edema, is highly suspicious for metastatic disease. Two additional 2-mm enhancing lesions on either side of the left post-central sulcus are also very suspicious for metastases. All three lesions are new from the prior exam.2.Complete occlusion of the right ICA is seen at its origin from the bifurcation. No flow is seen until the communicating segment intracranially where reconstitution does occur. Relatively normal caliber vessels are seen distal to this point suggesting adequate collateralization. Findings are unchanged from prior.3.Severe stenosis of the left ICA is seen at its origin from the bifurcation. Findings are unchanged from prior.4.Intracranial aneurysms are seen arising from the distal basilar artery and the left MCA bifurcation. There may be a small aneurysm arising from the ACOM artery, but this could be artifactual. 