66-year-old female patient with small cell lung cancer with brain metastases. Evaluate for progression. Redemonstration of numerous supratentorial and infratentorial enhancing lesions seen on a pretreatment scan from 12/25/2014 which remain decreased in size and similar to the most recent study on 6/22/2015 except for a right periventricular lesion along the right lateral ventricle (image 59, series 12). This lesion is more prominent on this examination and measures approximately 8 mm in the longest dimension, previously 6 mm. Many of these lesions are hemosiderin stained, appearing similar to the prior study. A formerly large extra-axial lesion along the right frontal lobe, now a hemosiderin stained cystic space, continues to decrease in size.Multiple enhancing lesions which were new on the prior examination compared to the pretreatment study have continued to increase in size. A lesion along the right superior frontal gyrus measures approximately 7 mm, previously 4 mm. A lesion along the orbital gyrus of the right inferior frontal lobe measures approximately 7 mm, previously 6 mm. A lesion along the left frontal operculum measures approximately 6 mm, previously 4 mm. A lesion on the left precuneus measures approximately 7 mm, previously 5 mm. An additional lesion along the lateral left post-central gyrus is also larger in size (image 38, series 12). None of lesions are associated with significant parenchymal edema or mass effect. Abnormal periventricular T2 signal, particularly adjacent to the right frontal horn, is not significantly changed from prior study. The ventricles are stable size
1. Redemonstration of numerous formerly large enhancing lesions on the pretreatment study which remain decreased in size compared to the most recent study except for increased prominence of a right periventricular lesion.2. Interval continued increase in size of at least 5 enhancing lesions which were new on the most recent study on 6/22/2015 and not evident on the pretreatment study consistent with progressive metastatic disease. 