57-year-old female with intermittent headaches. Small cell lung cancer. Evaluate for metastases. Enhanced CT of brain:There is no evidence of normal enhancement of brain parenchymal or leptomeninges to suggest metastatic lesion. The cortical sulci, ventricular system and all CSF cisterns remain within normal limits for patient's stated age. There is heavy vascular calcification of intracranial vertebral arteries and bilateral cavernous carotid. I suspect subtle low-attenuation in the subcortical white matter of bilateral cerebral hemispheres. This findings are nonspecific however considering patients provided clinical data and heavy intracranial vascular calcification, the above findings may represent small vessel disease of indeterminate age. Follow-up with an MRI examination is recommended.Calvarium is intact. Mastoid air cells and middle ear cavities and limited view of paranasal sinuses are negative.
1.No evidence of metastatic disease to brain, leptomeninges or of the calvarium.2.Vascular calcification of bilateral intracranial vertebrals and cavernous carotids consistent with atherosclerotic disease.3.Minimal small vessel disease of indeterminate age is suspected. 