Male, 68 years old, with history of non-small cell lung cancer with brain metastases status post whole brain radiotherapy, now with vocal cord paralysis and dysphagia. Left piriform sinus mass status post ENT scope and biopsy. Multiple enhancing lesions are redemonstrated scattered through the cerebral hemispheres and cerebellum. These include punctate foci of solid enhancement measuring 2 to 3 mm in size located at the gray-white junction, as well as somewhat larger solidly enhancing nodules in the bilateral cerebellum, and ring-enhancing lesions measuring between 1 and 2 cm including one in the right superior frontal gyrus and several in the inferior left cerebellum. Some of these lesions demonstrate associated susceptibility effect. However, none produce any significant edema in the surrounding parenchyma.No evidence of generalized mass effect is seen. Additional scattered small foci of T2 hyperintensity are noted without correlating pathologic enhancement. No findings are seen to suggest acute intracranial hemorrhage. Ventricular size and morphology are within normal limits. No abnormal extra-axial collections are detected.
Multiple enhancing lesions are redemonstrated scattered through the cerebral hemispheres and the cerebellum. These range from punctate solidly enhancing foci to somewhat larger rim-enhancing, hemosiderin stained lesions. Given the patient's history, it is possible that several of the above-mentioned lesions represent prior treated metastases, though it seems likely that some of the lesions probably reflect active metastatic deposits. Comparison with prior examinations may be helpful if these can be made available.