Reason: eval for changes in hemorrhagic enhancing lesions of uncertain etiology. Prior LP was negative. Pt w/ NSCLC. History: abnml brain MRI.. Multiple enhancing supratentorial and infratentorial metastases, some with increased intrinsic T1 signal, have overall progressed. Lesion in the right paracentral lobule measures 1.0 cm (1101/22), previously 0.9 cm. Lesion in the right inferior frontal gyrus measures 0.8 cm, unchanged. Lesion in the right periatrial white matter measures 0.9 x 0.7 cm, previously 0.7 x 0.6 cm. Multiple additional lesions, including lesions in the right frontal lobe and left occipital lobe are slightly increased in size. Gyriform enhancement along the right temporal lobe is also increased and likely reflects leptomeningeal disease. Scattered foci of susceptibility corresponding to lesions are compatible with blood products, some of which are slightly increased. No significant mass effect or edema from these lesions.A few scattered punctate periventricular and subcortical T2 hyperintensities are unchanged. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.
Mild enlargement of multiple small supra- and infratentorial hemorrhagic enhancing lesions consistent with metastases. Evidence of leptomeningeal disease again noted. No significant edema, mass effect, or herniation. 