Reason: 72y F with lung adenocarcinoma History: lung adenocarcinoma staging. Please note several post gadolinium sequences are motion degraded limiting sensitivity for small lesions. There is residual enhancing lesion involving the posterior aspect of the right superior temporal gyrus measuring 6 x 7 mm. There is also an enhancing lesion involving the left lateral occipital lobe measures approximately 7 x 5 mm, axial image 15 of series 10. These lesions demonstrate mild restricted diffusion. There are multiple additional foci of mild restricted diffusion including the medial aspect of the right thalamus as well as involving the right posterior frontal lobe without definite enhancement appreciated on the limited post gadolinium sequences.There is focus of susceptibility effect involving the left temporal white matter which is compatible with a chronic microhemorrhage and nonspecific. There is mild to FLAIR hyperintensity associated with the above-mentioned lesions without evidence of significant edema or mass effect. There are scattered foci of T2 hyperintensity within the periventricular and subcortical white matter, which are nonspecific but compatible with mild chronic small vessel ischemic disease. No hydrocephalus. No extra-axial collections. No midline shift or herniation. Bone marrow signal and intracranial soft tissues are unremarkable.
Motion degraded postcontrast sequences limit sensitivity for small lesions. There are at least 2 subcentimeter enhancing lesions involving the right temporal and left occipital lobes which are suspicious for metastatic disease. There is mild restricted diffusion associated with these lesions. There are also at least 2 other foci of restricted diffusion without definite enhancement appreciated. As such, these may represent additional metastatic foci versus punctate infarcts. There is a small possibility that two enhancing lesions are related to subacute infarcts but is felt to be less likely. Follow-up MRI with contrast with sedation would be helpful for differentiation.No significant edema or mass effect.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.