72 years, Male, new diagnosis small cell lung cancer, evaluate for brain metastases. No intracranial mass or mass-effect. No abnormal parenchymal or meningeal enhancement. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Chronic lacunar infarcts are also evident involving the right frontal corona radiata and right external capsule. Brain parenchyma is otherwise unremarkable for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. There is severely diminutive caliber of the right internal carotid artery flow-void with some enhancement. Bone marrow signal and extracranial soft tissues are grossly within normal limits.
1. No evidence of intracranial metastatic disease.2. Suspected high-grade stenosis versus occlusion involving the right internal carotid artery. Suggest MRA or CTA of the head and neck for further evaluation.3. Mild chronic small vessel ischemic disease as well as chronic lacunar infarcts involving the right frontal corona radiata and external capsule.