55yo M with stage III NSCLC s/p neoadjuvant chemoRT. Intermittent left leg numbness. MRI brain to rule out metastases. There is motion degradation on multiple sequences which may limit detection of subtle lesions. There is a 3 mm focus of enhancement in the right paramedian frontal lobe, series 13 image 24, series 14 image 16 suspicious for tiny metastasis. This lesion is not evident on prior study from 8/12/2016. There is otherwise no intracranial mass or abnormal parenchymal or meningeal enhancement elsewhere to indicate metastatic disease. No restricted diffusion to suggest acute ischemia. No intracranial mass effect, midline shift, or herniation. Ventricles are normal in size. No extra-axial collections.Few foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with minimal chronic small vessel ischemic changes. Focal T2/FLAIR hyperintensity involving the left superior frontal gyrus is unchanged and may be related to prominent perivascular spaces or possibly remote ischemia. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.There is a right maxillary sinus mucus retention cyst which is again seen. There is nonspecific heterogeneity of the bone marrow without discrete destructive osseous lesion evident. Orbits and remainder of the extracranial soft tissues are grossly unremarkable.
1. There is a subtle 3 mm focus of enhancement in the right paramedian frontal lobe which is suspicious for a metastasis. Note examination is motion degraded which limits assessment for subtle lesions. Short-term follow-up/repeat post gadolinium sequences can be considered as clinically warranted.2. Minimal chronic small vessel ischemic changes. No evidence of acute infarct. 