Clinical question: Metastatic lung cancer, brain metastases, status post RT, status post 4 cycles of Alectinib. Compared to prior exam. Signs and symptoms: Brain metastases. Pre and post enhanced brain MRI:Negative diffusion weighted series.There is revisualization of a focus of FLAIR hyperintensity in the pattern of vasogenic edema surrounding the right central sulcus without detectable mass effect or definitive interval change since prior study. Postcontrast images demonstrate further decreased leptomeningeal enhancement at this site to near complete resolution. There is no measurable focus of enhancement for comparison.Admission nearly a previously noted tiny focus of susceptibility and enhancement along the interhemispheric aspect of the right frontal lobe demonstrate interval improvement and only trace residual enhancement at this site.There is no detectable new foci of edema or abnormal parenchymal-meningeal enhancement since prior exam. Ventricular system and CSF spaces are within normal for age and midline is maintained.
1.Further improvement to near complete resolution of the leptomeningeal enhancement surrounding the right central sulcus since prior study. Stable associated FLAIR hyperintensity and susceptibility signal changes at this level.2.Further decrease in a tiny focus of meningeal enhancement with susceptibility signal changes in the right frontal size prior exam.3.Unremarkable exam otherwise and stable since prior study.