Clinical question: Restaging of NSCLC -- blurry vision, evaluate for optic nerve. Signs and symptoms: As above. Pre-and post-enhanced brain MRI:Negative diffusion weighted images. Revisualization of previously noted focus of increased signal intensity on diffusion weighted images at the level of previously treated tumor lateral to the left thalamus stable since prior exam and without evidence of enhancement.Stable post operative changes of left frontal craniotomy for removal of tumor with revisualization of a tiny linear enhancement along the posterior surgical cavity wall representing posttreatment change.Stable residual flair hyperintensity surrounding the surgical cavity consistent with paralysis.Stable diffuse periventricular and subcortical white matter flair hyperintensity in bilateral cerebral hemispheres consistent with posttreatment /radiation changes.There is no detectable abnormal parenchymal, leptomeningeal or calvarial enhancement to suggest metastatic disease.Unremarkable images through the orbits including axial fat sat post enhanced series. Although this is not a dedicated CT scan for assessment of optic nerves there is no detectable abnormality of the optic nerves in this study. If clinical concern for optic nerve pathology persists recommend dedicated MRI of the orbits. Unremarkable signal void of major intracranial arterial branches.The signal void of intracranial venous sinuses are within normal and with normal pattern of enhancement. Minimal ethmoid sinus disease and unremarkable paranasal sinuses otherwise.Extensive opacification of bilateral mastoid air cells without suggestion of opacification of middle ear cavities similar to prior exam.
1.No detectable acute or new finding since prior study.2.No detectable abnormality of the orbits and optic nerves on this nondedicated exam.3.Stable post surgical changes of left frontal tumor resection without recurrence.4.Focus of T2 hyperintensity without enhancement lateral to the left thalamus representing treated metastases.5.No detectable abnormal parenchymal, meningeal, calvarial and orbital enhancement to suggest metastases.6.Diffuse opacification of bilateral mastoid air cells without involvement of middle ear cavities similar to prior exam.