Clinical question: Eval for growth of lesions in temporal lobe and for growth of retinal mets from NSCLC. Pt s/p recent RT to orbits. Please obtain orbital cuts/.Signs and Symptoms: Retinal mets. Parenchymal brain mets. Probable RT-related changes in brain. S/p recent orbital RT. NSCLC. Pre-and post enhanced brain MRI:Examination demonstrates slight interval decreased size of the left posterior temporal hemorrhagic metastatic lesion. It measures approximately at 24 x 18 x 21-mm compared to prior study measurements of 26 x 23 x 23 millimeters. A second small enhancing metastatic lesion in the left anterior temporal lobe also demonstrates subtle interval decreased size. It measures at 10 x 8.5-mm compared to prior study measurements of 12.5 x 8mm.there is no detectable additional foci of parenchymal or leptomeningeal enhancement.A tiny focus of susceptibility in the right anterior temporal tip without enhancement demonstrate no change. Extensive white matter flair hyperintensity without mass effect also remains identical to prior study and likely representing post treatment/radiation related finding. Prominence of cortical sulci and mild prominence of lateral ventricles similar to prior exam and suspect of underlying parenchymal volume loss.Pre-and post enhanced MRI of orbits:Examination demonstrates no convincing evidence of a visible metastatic lesion in this exam. This is a similar observation is prior to exam and could be secondary to very small size of the lesions .
1.Pre-and post enhanced brain MRI demonstrate interval decreased size of a hemorrhagic metastatic lesion in the left superior temporal gyrus and left anterior temporal tip since prior exam as detailed/measured above.2.There is no detectable metastatic lesions on MRI of orbits.3.Stable tiny focus of susceptibility without enhancement in the right anterior temporal lobe.4.Diffuse white matter flair hyperintensity of cerebral hemispheres likely treatment related also remains stable since prior exam.