Clinical question: Newly diagnosed lung cancer, evaluate for metastases. Signs and symptoms: Lung cancer. Pre-and post-enhanced brain MRI: No diffusion weighted abnormalities.Examination demonstrate multiple metastatic lesions in bilateral cerebral and cerebellar hemispheres. The lesions demonstrate enhancement and some with a venous of central necrosis. There is also surrounding beaking edema. The largest parenchymal metastatic lesion is seen the right thalamus and measuring approximately at 21 x 28-mm and with areas of central necrosis and extensive surrounding edema. This lesion causes but a subtle deviation of third ventricle to the. The largest metastatic lesion in the posterior fossa is in the right inferior cerebellar and measuring at 18 times 17-mm which also demonstrate rim enhancement and central necrosis with subtle surrounding vasogenic edema and regional mass-effect.  Additionally there is a large extra axial dural based enhancing tumor arising from the right greater wing of the sphenoid and extends along the dural into the right subfrontal region along the floor of the right anterior cranial fossa. It demonstrate isointense signal on flair and T2-weighted images and with diffuse enhancement. It applies mass effect and posterior displacement of right anterior temporal lobe and superior displacement of the right frontal lobe. It measures at least 25 x 36 in transaxial and 41-mm in cranial cephalad axis. This finding is not associated with any underlying destructive bony changes. The lesion is highly suggestive of a meningioma and less likely to represent a metastatic disease.No detectable abnormal calvarial signal abnormality or enhancement to suggest metastases.Unremarkable images through the orbits including axial fat sat post enhanced series.Extensive chronic right maxillary sinus disease and unremarkable other paranasal sinuses.
1.Pre-and post enhanced brain MRI demonstrate multiple bilateral cerebral and cerebellar metastatic lesions as detailed/measured above. There is trace deviation of third ventricle to the left.2.A large well-demarcated dural based isointense mass with uniform enhancement arising from the right greater wing of sphenoid and extending along the dura to the right subfrontal region without detectable destructive bony changes as detailed. Finding is highly suggestive of a meningioma and less likely representing a metastatic lesion.