Small cell lung cancer. Restaging. Rule out brain metastasis. A tiny focus of contrast enhancement in the lateral most aspect of the right putamen (best seen in the axial fat-saturated postcontrast sequence; on image #18 of series #12) is related to one of the lenticulostriate vessels as evident on the 3D T1 postcontrast axial images. There is no abnormal brain or leptomeningeal contrast enhancement. There is no space-occupying brain lesion or mass-effect. There is also no abnormal brain diffusion restriction.Moderate periventricular T2-hyperintense signal without diffusion restriction is compatible with chronic microvascular ischemia and was present on the previous CT had. Similar changes are present in the dorsal pons. In addition, focal parenchymal loss and adjacent abnormal signal, compatible with encephalomalacia, in the right frontal lobe is unchanged from previous CT scan and probably relates to chronic infarct. The ventricles and the other CSF-containing spaces are moderately enlarged, reflective of global volume loss. Accounting for a small intracranial right vertebral artery, the major intracranial vascular flow voids are preserved, reflecting gross patency. Fluid in the mastoid air cells can be congestive. There is no destructive skull lesion.
1.There is no space-occupying or contrast-enhancing brain or leptomeningeal abnormality to indicate intracranial metastasis.2.Findings of moderate chronic microvascular ischemia and diffuse brain volume loss as well as chronic right frontal infarct remain unchanged.