Reason: h/o lung ca, r/o mets History: none The CSF spaces are appropriate for the patient's stated age with no midline shift. There are subtle subtle T1 signal hyperintense small lesions located in the right thalamus, left putamen, left caudate nucleus, right posterior insular cortex and two at the right precentral gyrus (one at the hand motor area and another leg area). These are not associated with contrast enhancement. These were not clearly identified on the prior exam.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. There are additional T2 and flair signal hyperintensities within the pons - left more than right - and right thalamus which are not readily identified on the prior exam.Punctate foci of low signal on susceptibility-weighted imaging are present in the globus pallidi. Another one is present in the left hippocampus. These are stable and likely of little clinical relevance.Cortical T1 and FLAIR signal hyperintensities identifiable on the prior exam along the fusiform gyri just above the petrous bones are not identified on the current exam. They are located in an area where artifact may occur depending on the image acquisition. Please refer to comments from the prior report as these may be artifactual. The significance is thus uncertain.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate minor opacities in the right mastoid air cells. The visualized portions of the orbits are intact. The eyeball lenses are thin.
1.There is small lesions present in the right thalamus, left putamen, left caudate nucleus, right posterior insular cortex and two at the right precentral gyrus which are not identified on the prior exam. These are not typical for metastases, though it is conceivable in the appropriate clinical setting that they are related to partially treated metastases or atypical non-enhancing metastases. The possibility that these are benign cannot be excluded.2.Small lesions in the left pons and right thalamus are also new. These may be vascular related.3.Periventricular and subcortical white matter changes of a mild degree are nonspecific but stable. At this age they are most likely vascular related. 4.Cortical T1 and FLAIR signal hyperintensities identifiable on the prior exam along the fusiform gyri just above the petrous bones are not identified on the current exam. They are located in an area where artifact may occur depending on the image acquisition. Please refer to comments from the prior report as these may be artifactual. The significance is thus uncertain.