Diagnosis: Secondary malignant neoplasm of brain and spinal cordClinical question: 58 yo F with metastatic NSCLC to brain, eval for number of mets The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a punctate enhancing lesion present in the right cerebellar hemisphere in the inferior semilunar lobule. A similar sized lesion is present in the left inferior semilunar lobule of the left cerebellar hemisphere. Another punctate lesion is present along the posterior aspect of the right pons which was also present on the prior exam.A couple lesions along the right inferior parietal lobule are not readily identified on the current exam.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.There are several punctate lesions present in the cerebellar hemispheres and pons which are suspicious for metastatic disease. Lesions previously identifiable in the right inferior parietal lobule are not readily identified on the current exam. Please note that the visualized lesions are less conspicuous on the current exam versus the prior exam.2.Please note that this examination is somewhat limited and specifically acquired for the purpose of stereotactic guidance during treatment.