Clinical question: Assess for progression of disease, history of SCC of lung with metastases to brain. Signs and symptoms: Altered mental status. Pre-and post-enhanced brain MRI:Negative diffusion weighted images for acute ischemic stroke.Previously noted two metastatic foci in the vermis demonstrates subtle interval increased size. The larger midline lesion measuring at 13-mm compared to prior study measurement of 11. There is a tiny metastatic lesion in the right lateral aspect of the pons with interval increased size since prior exam and measuring at approximately 2.8 mm in size. No surrounding edema or mass effect.Images through supratentorial space demonstrate multiple parenchymal metastatic lesions which demonstrate interval increase size since prior study. A superficially located left posterior temporal lobe because the lesion measuring at 13.5-mm has increased since prior exam measurement of 9. A right parietal cingulate gyrus metastases lesion measuring at 14.5-mm compared to prior study measurement of 10.5mm.A left posterior parietal metastatic lesion measuring 18.8 x 14.4-mm has increased since prior exam measurement of 11.7 times 12-mm.there is extensive flair hyperintensity of bilateral hemispheric white matter with disproportionately less mass effect is due to represent a combination of peritumoral edema and post treatment/radiation change. Ventricular system remains within normal size and maintained midline.There is no evidence of calvarial or soft tissues of the scalp metastatic lesions. Unremarkable images through the orbits and including axial fat sat post enhanced series.
1.Interval progression of metastatic disease demonstrating increased size of all supratentorial and infratentorial metastatic lesions as detailed/measured above.2.Fairly extensive flair hyperintensity of bilateral hemispheric white matter is believed to represent a combination of peritumoral edema and post treatment/radiation change. This appearance remains fairly similar to prior exam.3.Stable normal size of ventricular system and without evidence of midline shift.4.No detectable calvarial, soft tissues of the scalp or orbital metastatic lesions.