Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: metastatic NSCLC with new brain metastases s/p radiosurgery; please evaluate for responseSigns and Symptoms: brain metastases The CSF spaces are appropriate for the patient's stated age with no midline shift. A previously measuring 5 mm nodule in the right cuneus near the parieto-occipital sulcus now measures 2 mm. A ring-enhancing lesion in the right occipital lobe previously measuring 6 mm now measures 3 mm. A right cerebellar lesion measuring 4 mm on the prior exam now measures 2 mm. A left cerebellar lesion previously measuring 2 mm is not readily identified.A 14 mm x 7 mm FLAIR signal hyperintensity along the left superior frontal gyrus subcortical white matter remains stable.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images which are not associated with contrast enhancement and are stable compared to the prior exam.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 are clear. The visualized portions of the orbits are intact.
1.Since the prior exam multiple enhancing nodules in the occipital lobes and cerebellum have decreased in size.