Newly diagnosed lung cancer, staging exam. There is a 6x6 mm peripherally enhancing lesion in the right frontal lobe anteriorly along the cortical surface (axial post gad series 12 image 71/184) and 8x5 mm peripherally enhancing lesion in the left superior cerebellar hemisphere. No significant associated edema. No evidence of mass effect, midline shift, or herniation.There is extensive encephalomalacia involving the left greater than right frontal lobes, and the left anterior temporal lobe, which may related to prior trauma. Additional focal areas of encephalomalacia also noted involving the right paracentral lobule and the left superior parietal lobule. There are foci of susceptibility consistent with hemosiderin deposition associated with many of these areas as well as along the right cortical surface in the right parieto-occipital region. There is severe volume loss involving the callosal genu consistent with Wallerian degeneration. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. No hydrocephalus. Several scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There are mucous retention cysts in the maxillary sinuses.There is a 4 cm area of low T1 hyperintensity, restricted diffusion, and enhancement involving the right frontal calvarium. Additional area of abnormal enhancement is suspected in the left parietal calvarium (axial postgad sequence 10 image 5/29).
1. 6 mm right frontal lobe and 8 mm left cerebellar peripherally enhancing lesions are suspicious for metastatic disease. These are better seen on the postgadolinium 3D FSPGR sequence. No significant associated edema or mass effect.2. Extensive mutlifocal areas of encephalomalacia, particularly left greater than right frontal lobes and anterior left temporal lobes, with multiple areas of hemosiderin deposition. These are favored to be related to prior trauma.3. 4 cm right frontal area of enhancement in the calvarium. Unclear if this represents a large calvarial metastasis, related to possibly prior surgery, or other osseous lesion. CT would be helpful to better assess the osseous anatomy in this region. Additional subcentimeter enhancing lesion is seen in the left parietal calvarium. Recent PET-CT does not include these regions.